Provider Demographics
NPI:1598880049
Name:RICHARDSON, STEFANIE REBECCA
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:REBECCA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:REBECCA
Other - Last Name:SCHWARTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3327
Mailing Address - Country:US
Mailing Address - Phone:856-802-1223
Mailing Address - Fax:
Practice Address - Street 1:566 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1444
Practice Address - Country:US
Practice Address - Phone:856-858-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05212400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker