Provider Demographics
NPI:1053432641
Name:TEITELBAUM, STEFANIE C (LSCW)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:C
Last Name:TEITELBAUM
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 5TH AVE
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7002
Mailing Address - Country:US
Mailing Address - Phone:212-255-3284
Mailing Address - Fax:
Practice Address - Street 1:156 5TH AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7002
Practice Address - Country:US
Practice Address - Phone:212-255-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047480-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical