Provider Demographics
NPI:1396828026
Name:STOCKELBERG, SHOSHANA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:STOCKELBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHOSHANA
Other - Middle Name:
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:75 E PARSONAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7945
Mailing Address - Country:US
Mailing Address - Phone:732-547-5082
Mailing Address - Fax:732-431-4892
Practice Address - Street 1:81 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1700
Practice Address - Country:US
Practice Address - Phone:732-547-5082
Practice Address - Fax:732-431-4892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052766001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750764908OtherNPI 2