Individual
DR. STEPHANIE HELENA POPLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, LCSW
Contact information
Practice address
242 MAIN STREET, ONEONTA, NY 13820
(607) 433-2343
(607) 433-6229
Mailing address
242 MAIN STREET, ONEONTA, NY 13820
(607) 433-2343
(607) 433-6229
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
018721
NY
1041C0700X
Clinical Social Worker
077995
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03641807
—
NY
01
—
098304
ANTHEM LEGACY NUMBER
ME
05
—
421230099
—
ME
01
—
J400040149
MEDICARE PTAN
NY
Enumeration date
06/13/2006
Last updated
07/01/2020
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