Basic Information
| Provider Information | |||||||||
| NPI: | 1538553235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOAN | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MHC, CASAC-T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 281 PHELPS LN | ||||||||
| Address2: | DRUG AND ALCOHOL SERVICES | ||||||||
| City: | NORTH BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117034005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314227676 | ||||||||
| FaxNumber: | 6314227609 | ||||||||
| Practice Location | |||||||||
| Address1: | 281 PHELPS LN | ||||||||
| Address2: | DRUG AND ALCOHOL SERVICES | ||||||||
| City: | NORTH BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117034005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314227676 | ||||||||
| FaxNumber: | 6314227609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2015 | ||||||||
| LastUpdateDate: | 03/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 28667 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | P92408 | NY | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.