Provider Demographics
NPI:1457858359
Name:LONG, STEPHANIE ROSHELLE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSHELLE
Last Name:LONG
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 1:233 PROSPECT ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-2861
Mailing Address - Country:US
Mailing Address - Phone:973-592-7093
Mailing Address - Fax:
Practice Address - Street 1:233 PROSPECT ST APT 3C
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-2861
Practice Address - Country:US
Practice Address - Phone:973-592-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor