Provider Demographics
NPI:1578747523
Name:PICKENS, STEFANIE JEAN (LCSWR)
Entity type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:JEAN
Last Name:PICKENS
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 A CLAYTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2430
Mailing Address - Country:US
Mailing Address - Phone:607-754-1101
Mailing Address - Fax:607-754-1107
Practice Address - Street 1:116 A CLAYTON AVENUE
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2430
Practice Address - Country:US
Practice Address - Phone:607-754-1101
Practice Address - Fax:607-754-1107
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078116104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400052461Medicare PIN