Basic Information
| Provider Information | |||||||||
| NPI: | 1740904705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCAMUFFO | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | JULIA | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 117TH ST APT 2 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100262267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034239377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2090 ADAM CLAYTON POWELL JR BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125536708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2022 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 117128 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 117128 | 05 | NY | MEDICAID |