Provider Demographics
NPI:1942409404
Name:DAURIO, STEPHEN P (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:DAURIO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MIDWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2510
Mailing Address - Country:US
Mailing Address - Phone:718-983-5376
Mailing Address - Fax:
Practice Address - Street 1:222 MIDWOOD PL
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2510
Practice Address - Country:US
Practice Address - Phone:718-983-5376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009135-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01517711Medicaid