Provider Demographics
NPI:1982217956
Name:DIRAIMONDO, STEPHANIE NOELLE (MS ED, NCC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:NOELLE
Last Name:DIRAIMONDO
Suffix:
Gender:F
Credentials:MS ED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:386 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1608
Mailing Address - Country:US
Mailing Address - Phone:516-640-7270
Mailing Address - Fax:
Practice Address - Street 1:727 N BROADWAY STE C1
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2348
Practice Address - Country:US
Practice Address - Phone:516-243-7909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP111932101YM0800X
NY2970164101YS0200X
NY013702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool