Provider Demographics
NPI:1336591098
Name:AVAGLIANO, STEPHANIE M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:M
Last Name:AVAGLIANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:DERICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1401 STONE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1537
Mailing Address - Country:US
Mailing Address - Phone:585-690-7591
Mailing Address - Fax:585-805-3621
Practice Address - Street 1:1401 STONE RD STE 301
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1537
Practice Address - Country:US
Practice Address - Phone:585-690-7591
Practice Address - Fax:585-805-3621
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health