Provider Demographics
NPI:1861103129
Name:HEALEY, STEPHEN (BA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:HEALEY
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-2318
Mailing Address - Country:US
Mailing Address - Phone:518-860-6270
Mailing Address - Fax:
Practice Address - Street 1:30 VERNON AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-2318
Practice Address - Country:US
Practice Address - Phone:518-860-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst