Provider Demographics
NPI:1720581028
Name:ZITANI, STEPHANIE L (MS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:ZITANI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442D COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6429
Mailing Address - Country:US
Mailing Address - Phone:609-389-9509
Mailing Address - Fax:732-505-5308
Practice Address - Street 1:442D COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6429
Practice Address - Country:US
Practice Address - Phone:609-389-9509
Practice Address - Fax:732-505-5308
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00278800101YA0400X
NJ120-2003804-00101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ83-2411404Medicaid
NJ83-2411404OtherINSURANCE