Provider Demographics
NPI:1598849168
Name:SHOFFSTALL, STEPHANIE LYNN (LCSW/LICSW)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:SHOFFSTALL
Suffix:
Gender:F
Credentials:LCSW/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-0428
Mailing Address - Country:US
Mailing Address - Phone:856-514-0414
Mailing Address - Fax:
Practice Address - Street 1:144 MEACHAM ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2826
Practice Address - Country:US
Practice Address - Phone:856-514-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490129731041C0700X
NJ44SC059396001041C0700X
1041C0700X
MA1186771041C0700X
MA1186741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical