Basic Information
Provider Information
NPI: 1790955698
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CZERNIEWSKI
FirstName: STEFANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 339 HOLLOW RD
Address2:  
City: STAATSBURG
State: NY
PostalCode: 125805749
CountryCode: US
TelephoneNumber: 8458894287
FaxNumber:  
Practice Location
Address1: 26 OAKLEY ST
Address2:  
City: POUGHKEEPSIE
State: NY
PostalCode: 126012005
CountryCode: US
TelephoneNumber: 8454863570
FaxNumber: 8454863599
Other Information
ProviderEnumerationDate: 03/06/2008
LastUpdateDate: 03/06/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225C00000X00041-135NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor 

No ID Information.


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