Provider Demographics
NPI:1073837068
Name:STEPHAN, CHRISTINE ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANGELA
Last Name:STEPHAN
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 1:2 OLD PRALLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08559-2129
Mailing Address - Country:US
Mailing Address - Phone:609-971-8989
Mailing Address - Fax:
Practice Address - Street 1:500 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2228
Practice Address - Country:US
Practice Address - Phone:609-971-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC44002660001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical