Provider Demographics
NPI:1366877037
Name:STALLINGS-HARVELL, GODDESS FEMEL
Entity type:Individual
Prefix:
First Name:GODDESS
Middle Name:FEMEL
Last Name:STALLINGS-HARVELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GODDESS
Other - Middle Name:FEMEL
Other - Last Name:STALLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10501 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2704
Mailing Address - Country:US
Mailing Address - Phone:718-850-7099
Mailing Address - Fax:718-850-9361
Practice Address - Street 1:10501 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-850-7099
Practice Address - Fax:718-850-9361
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252485164W00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty