Provider Demographics
NPI:1710586052
Name:MANKOWSKI, STEPHANIE ANN (MA, LPCC, LADC, LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:MANKOWSKI
Suffix:
Gender:F
Credentials:MA, LPCC, LADC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 ELMWOOD AVE PMB 133
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:201-903-2461
Mailing Address - Fax:
Practice Address - Street 1:2604 ELMWOOD AVE PMB 133
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4185
Practice Address - Country:US
Practice Address - Phone:201-903-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304498101YA0400X
NY014274-01101YM0800X
CT6165101YM0800X
MN01912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)