Provider Demographics
NPI:1720147259
Name:STADE, VILMA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VILMA
Middle Name:
Last Name:STADE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 7TH ST
Mailing Address - Street 2:SUITE 200, EAST WING, 2ND FLOOR
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5747
Mailing Address - Country:US
Mailing Address - Phone:516-524-8570
Mailing Address - Fax:631-858-0237
Practice Address - Street 1:233 7TH ST
Practice Address - Street 2:SUITE 200, EAST WING, 2ND FLOOR
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5747
Practice Address - Country:US
Practice Address - Phone:516-524-8570
Practice Address - Fax:631-858-0237
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0322051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNB578OtherBCBS
NYP472527OtherOXFORD
NY7400344OtherVALUE OPTIONS
NYNB578OtherBCBS