Provider Demographics
NPI:1639584667
Name:STACKHOUSE, BONNIE JOY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:JOY
Last Name:STACKHOUSE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1930
Mailing Address - Country:US
Mailing Address - Phone:973-919-8113
Mailing Address - Fax:973-729-4611
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1930
Practice Address - Country:US
Practice Address - Phone:973-919-8113
Practice Address - Fax:973-729-4611
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-28
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014676001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical