Provider Demographics
NPI:1972577138
Name:TEMSHIV, STEPHANIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:TEMSHIV
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 1:1 BURHANS PLACE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:518-478-9930
Mailing Address - Fax:518-270-2723
Practice Address - Street 1:1 BURHANS PLACE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054
Practice Address - Country:US
Practice Address - Phone:518-478-9930
Practice Address - Fax:518-270-2723
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR04394611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01735280Medicaid
NY56541BMedicare ID - Type Unspecified