Provider Demographics
NPI:1932460730
Name:STEPHEN ANDREOPOULOS PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:STEPHEN ANDREOPOULOS PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:ANDREOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-739-0234
Mailing Address - Street 1:143 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2610
Practice Address - Country:US
Practice Address - Phone:516-739-0234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02607936Medicaid
NYVN1541Medicare PIN