Provider Demographics
NPI:1649837097
Name:STOCKER HEADLEY, MEGAN
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:STOCKER HEADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 8TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3605
Mailing Address - Country:US
Mailing Address - Phone:434-409-4211
Mailing Address - Fax:
Practice Address - Street 1:250 PARK AVE FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10177-0799
Practice Address - Country:US
Practice Address - Phone:434-409-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021096101YM0800X
NY011296101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health