Provider Demographics
NPI:1629685516
Name:DAMORE, STEFANIE A (MA,LPC)
Entity Type:Individual
Prefix:MS
First Name:STEFANIE
Middle Name:A
Last Name:DAMORE
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WOODPORT RD STE 209
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2645
Mailing Address - Country:US
Mailing Address - Phone:973-512-3700
Mailing Address - Fax:973-512-3701
Practice Address - Street 1:191 WOODPORT RD STE 209
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2645
Practice Address - Country:US
Practice Address - Phone:973-512-3700
Practice Address - Fax:973-512-3701
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00729900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional