Provider Demographics
NPI:1366564601
Name:STIEHL, MARY ELLEN M (MA EDS PHD)
Entity type:Individual
Prefix:DR
First Name:MARY ELLEN
Middle Name:M
Last Name:STIEHL
Suffix:
Gender:F
Credentials:MA EDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401
Mailing Address - Country:US
Mailing Address - Phone:201-760-0795
Mailing Address - Fax:
Practice Address - Street 1:175 E CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401
Practice Address - Country:US
Practice Address - Phone:201-760-0795
Practice Address - Fax:201-760-1081
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001428101YM0800X, 103TA0400X, 103TC1900X, 103TP0814X, 103TS0200X
NJ37F100122000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223332735OtherEIN
NJ223332735OtherEIN