Provider Demographics
NPI:1225183411
Name:WILL, STEPHANIE JEANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JEANNE
Last Name:WILL
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 1:677 TOMLINSON LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-6329
Mailing Address - Country:US
Mailing Address - Phone:215-321-4787
Mailing Address - Fax:215-757-2115
Practice Address - Street 1:4 CORNERSTONE DR.
Practice Address - Street 2:FAMILY SERVICE ASSOCIATION
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:215-757-2115
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0143841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008123 J9PMedicare ID - Type Unspecified