Provider Demographics
NPI:1437427192
Name:COLUMBIA, STEPHANIE (LCSW-R, BCBA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:COLUMBIA
Suffix:
Gender:F
Credentials:LCSW-R, BCBA
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 361
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-0361
Mailing Address - Country:US
Mailing Address - Phone:516-526-1814
Mailing Address - Fax:
Practice Address - Street 1:127 E MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2440
Practice Address - Country:US
Practice Address - Phone:516-526-1814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-11-8597103K00000X
NY0759201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst