| Theodora Stolz Clinic | |
|
68 Guyon Ave S I NY 10306 | |
| (718) 980-3780 | |
| (718) 987-6113 |
| Full Name | Theodora Stolz Clinic |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 68 Guyon Ave, S I, New York |
| Authorized Official Name and Position | Theodora Stolz (PRESIDENT) |
| Authorized Official Contact | 7189803780 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodora Stolz Clinic 68 Guyon Ave S I NY 10306 Ph: (718) 980-3780 | Theodora Stolz Clinic 68 Guyon Ave S I NY 10306 Ph: (718) 980-3780 |
| NPI Number | 1912081787 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912081787 | NPI | - | NPPES |
| 01627747 | Medicaid | NY | |
| 0028533 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 010825 (New York) | Primary |
| 103TC0700X | Psychologist - Clinical | 3222 (New Jersey) | Secondary |