Provider Demographics
NPI:1053545483
Name:EDELSTEIN, STACEY ROBYN (MSW)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ROBYN
Last Name:EDELSTEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3126
Mailing Address - Country:US
Mailing Address - Phone:516-292-5432
Mailing Address - Fax:516-292-5432
Practice Address - Street 1:613 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-3126
Practice Address - Country:US
Practice Address - Phone:516-292-5432
Practice Address - Fax:516-292-5432
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherNYS TEACHER LICENSE