Provider Demographics
NPI:1861969529
Name:CODOS, STEPHANIE LAUREN (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:CODOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 85TH ST APT 707
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3082
Mailing Address - Country:US
Mailing Address - Phone:908-723-0425
Mailing Address - Fax:
Practice Address - Street 1:157 E 86TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2113
Practice Address - Country:US
Practice Address - Phone:908-723-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022922-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist