Provider Demographics
NPI:1023099728
Name:FAY, STEPHEN C (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:C
Last Name:FAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FRALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1524
Mailing Address - Country:US
Mailing Address - Phone:845-758-1107
Mailing Address - Fax:
Practice Address - Street 1:23H E MARKET ST
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1639
Practice Address - Country:US
Practice Address - Phone:845-473-4675
Practice Address - Fax:845-758-1107
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR026150-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7403800OtherGHI PIN NUMBER
NYP2775609OtherOXFORD PROVIDER NUMBER
NY108640OtherUBH PROVIDER NUMBER
NY349572OtherMVP PROVIDER NUMBER
NYN98491Medicare ID - Type UnspecifiedMEDICARE PROVDER NUMBER