Provider Demographics
NPI:1003243528
Name:STEPHENS, CAITLYN (LCSW)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:ASBURY PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-0959
Mailing Address - Country:US
Mailing Address - Phone:732-705-1082
Mailing Address - Fax:
Practice Address - Street 1:482 BRICK BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6077
Practice Address - Country:US
Practice Address - Phone:732-705-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-29
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05904100104100000X
NJ44SC057464001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker