Provider Demographics
NPI:1700059870
Name:STEPHENS, TRICIA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
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 1:306 GOLD ST
Mailing Address - Street 2:29C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3014
Mailing Address - Country:US
Mailing Address - Phone:646-504-6853
Mailing Address - Fax:718-797-3181
Practice Address - Street 1:306 GOLD ST
Practice Address - Street 2:29C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3014
Practice Address - Country:US
Practice Address - Phone:646-504-6853
Practice Address - Fax:718-797-3181
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0749231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical