Provider Demographics
NPI:1578720942
Name:STEVENS, DEANA NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:NICOLE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 AMBOY AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2438
Mailing Address - Country:US
Mailing Address - Phone:732-735-2146
Mailing Address - Fax:
Practice Address - Street 1:340 AMBOY AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2438
Practice Address - Country:US
Practice Address - Phone:732-735-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00451900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical