Provider Demographics
NPI:1053367466
Name:STELLATO-KABAT, JOANNA (LCSW)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:STELLATO-KABAT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2657
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12325-0657
Mailing Address - Country:US
Mailing Address - Phone:518-370-0158
Mailing Address - Fax:877-296-7673
Practice Address - Street 1:864 BEECH DR
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-3027
Practice Address - Country:US
Practice Address - Phone:518-370-0158
Practice Address - Fax:877-296-7673
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027188-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNISKAY(000)OtherPROVIDER NUMBER
NYNISKAY(000)OtherPROVIDER NUMBER
NYCC3962Medicare ID - Type Unspecified