Basic Information
Provider Information | |||||||||
NPI: | 1992945075 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | STEMBER | ||||||||
FirstName: | LINDA | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 445 OAK ST | ||||||||
Address2: |   | ||||||||
City: | COPIAGUE | ||||||||
State: | NY | ||||||||
PostalCode: | 117263111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316917080 | ||||||||
FaxNumber: | 6316913387 | ||||||||
Practice Location | |||||||||
Address1: | 445 OAK ST | ||||||||
Address2: |   | ||||||||
City: | COPIAGUE | ||||||||
State: | NY | ||||||||
PostalCode: | 117263111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316917080 | ||||||||
FaxNumber: | 6316913387 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/02/2009 | ||||||||
LastUpdateDate: | 05/16/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 081894 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.