Provider Demographics
NPI:1437366606
Name:STERN, RONNIE PHYLLIS
Entity Type:Individual
Prefix:MRS
First Name:RONNIE
Middle Name:PHYLLIS
Last Name:STERN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HICKORY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2107
Mailing Address - Country:US
Mailing Address - Phone:973-762-0289
Mailing Address - Fax:973-762-2962
Practice Address - Street 1:169 MAPLEWOOD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2107
Practice Address - Country:US
Practice Address - Phone:973-762-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00139500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist