Provider Demographics
NPI:1467597260
Name:ANDREOPOULOS, STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:ANDREOPOULOS
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 1:444 CONTANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1106
Mailing Address - Country:US
Mailing Address - Phone:646-734-2885
Mailing Address - Fax:
Practice Address - Street 1:75 N MAPLE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3261
Practice Address - Country:US
Practice Address - Phone:646-734-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015522103T00000X
NJ35SI00640800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02607936Medicaid
NYVN1541Medicare ID - Type Unspecified