Provider Demographics
NPI:1770856023
Name:JOANNE STAVOLA LCSW LLC
Entity Type:Organization
Organization Name:JOANNE STAVOLA LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:STAVOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-403-9326
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:130 MAPLE AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1734
Practice Address - Country:US
Practice Address - Phone:732-403-9326
Practice Address - Fax:732-224-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty