Provider Demographics
NPI:1689566929
Name:DISTEFANO, ERIN (LMSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:12 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-2715
Mailing Address - Country:US
Mailing Address - Phone:845-325-2074
Mailing Address - Fax:
Practice Address - Street 1:35 BATH ST
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-1745
Practice Address - Country:US
Practice Address - Phone:518-245-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104868104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker