Provider Demographics
NPI:1669935599
Name:MATHELIER, STEPHANIE (MS, LMFT)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:MATHELIER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BROOKSIDE AVE UNIT 269
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-7519
Mailing Address - Country:US
Mailing Address - Phone:862-373-0470
Mailing Address - Fax:
Practice Address - Street 1:125 EVAN RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4022
Practice Address - Country:US
Practice Address - Phone:862-373-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001782-01106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health