Provider Demographics
NPI:1336210350
Name:GILES, STEVEN LLOYD (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LLOYD
Last Name:GILES
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 1:572 GRAND ST.
Mailing Address - Street 2:APT. 1902
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4343
Mailing Address - Country:US
Mailing Address - Phone:212-529-6183
Mailing Address - Fax:
Practice Address - Street 1:572 GRAND ST.
Practice Address - Street 2:APT. 1902
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4343
Practice Address - Country:US
Practice Address - Phone:212-529-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014434-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014434-1OtherPSYCHOLOGIST LICENSE
NY02129151Medicaid
NY014434-1OtherPSYCHOLOGIST LICENSE