Provider Demographics
NPI:1295393510
Name:STERN, ELLEN W (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:W
Last Name:STERN
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 1:1485 TEANECK RD FL 2
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3626
Mailing Address - Country:US
Mailing Address - Phone:201-906-2303
Mailing Address - Fax:
Practice Address - Street 1:17-10 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1252
Practice Address - Country:US
Practice Address - Phone:201-837-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058553001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical