Provider Demographics
NPI:1003972449
Name:PATILLO, STEPHEN (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:PATILLO
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LANDON DR
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1404
Mailing Address - Country:US
Mailing Address - Phone:609-291-9151
Mailing Address - Fax:609-882-3880
Practice Address - Street 1:1925 PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1105
Practice Address - Country:US
Practice Address - Phone:609-882-1898
Practice Address - Fax:609-882-3880
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047207001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical