Provider Demographics
NPI:1457414831
Name:DAVIE, STEPHEN H (LCSW-R)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:H
Last Name:DAVIE
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1001
Mailing Address - Country:US
Mailing Address - Phone:518-747-2994
Mailing Address - Fax:518-747-2996
Practice Address - Street 1:15 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1001
Practice Address - Country:US
Practice Address - Phone:518-747-2994
Practice Address - Fax:518-747-2996
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR012566-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTRI-CAREOther12034176
NYMVPOther377615
NYVALUE OPTIONSOther476662
NYVALUE OPTIONSOther7340690002
NYBCBS OF NE NYOther000403428001
NYFIDELISOther050721000016