Provider Demographics
NPI:1477022879
Name:FEGAN, STEPHANIE ROSE
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ROSE
Last Name:FEGAN
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 1:19 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3267
Mailing Address - Country:US
Mailing Address - Phone:201-739-0656
Mailing Address - Fax:
Practice Address - Street 1:19 COMMONS DR
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3267
Practice Address - Country:US
Practice Address - Phone:201-739-0656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041S0200X
NJ44SC057192001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool