Basic Information
| Provider Information | |||||||||
| NPI: | 1467515841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMBRA | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JEANNE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 WINDSOR AVENUE | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165946683 | ||||||||
| FaxNumber: | 5165946687 | ||||||||
| Practice Location | |||||||||
| Address1: | 119 WEST 57TH STREET | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127574488 | ||||||||
| FaxNumber: | 2127573555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R043464 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.