Provider Demographics
NPI:1013282607
Name:FRIEDMAN NELSON, STACEY (PHD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:FRIEDMAN NELSON
Suffix:
Gender:F
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ATLANTIC AVE
Mailing Address - Street 2:APT 29A
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3450
Mailing Address - Country:US
Mailing Address - Phone:516-792-1445
Mailing Address - Fax:516-792-1446
Practice Address - Street 1:108 ATLANTIC AVE
Practice Address - Street 2:APT 29A
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3450
Practice Address - Country:US
Practice Address - Phone:516-792-1445
Practice Address - Fax:516-792-1446
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0721211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical