Stillwater Psychological and Occupational Therapy Assoc PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

011241 Issued in NY

Legal business name

STILLWATER PSYCHOLOGICAL AND OCCUPATIONAL THERAPY ASSOC PLLC

Practice address

1840 Union Blvd
Bay Shore, NY 11706-7932

Phone

(631) 647-7885

Fax

(631) 647-7893

NPI assigned

Apr 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shafer Zyzman

Title

Ceo

Phone

(631) 647-7885

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick G. Andretta, PH.D.

  • Clinical Psychologist
  • Rego Park, NY
  • NPI 1124253265
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561161600000",
    "number": "1982666822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067932",
            "telephone_number": "631-647-7885",
            "fax_number": "631-647-7893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 UNION BLVD",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117067932",
            "telephone_number": "631-647-7885",
            "fax_number": "631-647-7893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STILLWATER PSYCHOLOGICAL AND OCCUPATIONAL THERAPY ASSOC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2019-06-22",
        "status": "A",
        "authorized_official_last_name": "ZYZMAN",
        "authorized_official_first_name": "SHAFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "631-647-7885"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "011241",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "NY",
            "license": "025669",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "009040",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02678068",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlin Marie Stevens, LCSW
• Nancy J Stevens, RN
• Lisa Lorraine Stiles, LCSW-R
• Stillwater Group of America
• Stillwater Occupational Therapy & Social Work Group, PLLC
• Stillwater Therapy LCSW P.C.
• Danielle Strafford, COTA/L
• Michael Streiter, M.D.
• Tida Stricoff-Calma, LCSW
• Colleen Stubbs

• Clinical Psychologist in Bay Shore, NY
• Providers in Bay Shore, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.