Provider Demographics
NPI:1033989587
Name:STEPHENS, BETSY (LSW)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622-624 VALLEY RD APT 5G
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1462
Mailing Address - Country:US
Mailing Address - Phone:862-330-1727
Mailing Address - Fax:
Practice Address - Street 1:622-624
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:862-330-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07012700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker