Provider Demographics
NPI:1245305036
Name:STAHL, EILEEN WATERBURY (PHD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:WATERBURY
Last Name:STAHL
Suffix:
Gender:F
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:PO BOX 3
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-0003
Mailing Address - Country:US
Mailing Address - Phone:973-831-1303
Mailing Address - Fax:973-835-4629
Practice Address - Street 1:44 STATE HWY 23 NO
Practice Address - Street 2:SUITE 3
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-0003
Practice Address - Country:US
Practice Address - Phone:973-831-1303
Practice Address - Fax:973-835-4629
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35S100395300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist