Provider Demographics
NPI:1326533449
Name:IGLESIAS, STEPHANIE MARIE (LSW, PHD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:LSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08344-5238
Mailing Address - Country:US
Mailing Address - Phone:856-300-9308
Mailing Address - Fax:
Practice Address - Street 1:677 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08344-5238
Practice Address - Country:US
Practice Address - Phone:856-300-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06357800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker