Provider Demographics
NPI:1326587973
Name:OMENS, STEPHANIE (MASTERS DEGREE)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:OMENS
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1704
Mailing Address - Country:US
Mailing Address - Phone:201-600-4665
Mailing Address - Fax:
Practice Address - Street 1:32 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1704
Practice Address - Country:US
Practice Address - Phone:201-600-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health