Provider Demographics
NPI:1366495467
Name:STERN, MIRIAM (MSW)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 WALNUT PL
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-3446
Mailing Address - Country:US
Mailing Address - Phone:856-816-7114
Mailing Address - Fax:856-303-1337
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:SUITE M 68
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-816-7114
Practice Address - Fax:856-303-1337
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051637001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7144432OtherAETNA
NJ2318907000OtherAMERIHEALTH
NJ531160OtherVALUE OPTIONS
NJ7144432OtherAETNA