Provider Demographics
NPI:1326173089
Name:STEPHENSON, CATHY LYNETTE (MS, PT, MSW)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:LYNETTE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:MS, PT, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1805
Mailing Address - Country:US
Mailing Address - Phone:973-509-0827
Mailing Address - Fax:973-509-0877
Practice Address - Street 1:552 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1805
Practice Address - Country:US
Practice Address - Phone:973-509-0827
Practice Address - Fax:973-509-0877
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01116600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085287UQMMedicare UPIN