Basic Information
| Provider Information | |||||||||
| NPI: | 1093472573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PELAIA | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16121 JAMAICA AVE FL 7 | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114326113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188962500 | ||||||||
| FaxNumber: | 7184596542 | ||||||||
| Practice Location | |||||||||
| Address1: | 475 ATLANTIC AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112174383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187172570 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2021 | ||||||||
| LastUpdateDate: | 11/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 106542 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.