Provider Demographics
NPI:1225255961
Name:169 N STEVENS INC
Entity Type:Organization
Organization Name:169 N STEVENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRIMARY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:D
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ASTARITA
Authorized Official - Suffix:I
Authorized Official - Credentials:LSW,MSW,LCADC
Authorized Official - Phone:732-525-1149
Mailing Address - Street 1:PO BOX 3251
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-3251
Mailing Address - Country:US
Mailing Address - Phone:732-525-1149
Mailing Address - Fax:732-727-6757
Practice Address - Street 1:147 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1639
Practice Address - Country:US
Practice Address - Phone:732-525-1149
Practice Address - Fax:732-727-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00112100101Y00000X, 101YA0400X
NJ44SL05295000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty