Provider Demographics
NPI:1093457152
Name:LONZA, DEIDRE STAMOS (LCSW, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:STAMOS
Last Name:LONZA
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2134
Mailing Address - Country:US
Mailing Address - Phone:732-859-5516
Mailing Address - Fax:
Practice Address - Street 1:800 RIVERVIEW DR STE 104
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1749
Practice Address - Country:US
Practice Address - Phone:732-526-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00296400101YA0400X
NJ44SC058292001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)