Basic Information
| Provider Information | |||||||||
| NPI: | 1013147537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9027 SUTPHIN BLVD | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114353631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185268400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9027 SUTPHIN BLVD | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114353631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185268400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2009 | ||||||||
| LastUpdateDate: | 06/29/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 080715 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.