Provider Demographics
NPI:1821528357
Name:STAIB, ELIZABETH M (LCSW, CEAP, SAP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:STAIB
Suffix:
Gender:F
Credentials:LCSW, CEAP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WEST END AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-1850
Mailing Address - Country:US
Mailing Address - Phone:856-534-5246
Mailing Address - Fax:
Practice Address - Street 1:1155 ROUTE 73 STE 18
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2352
Practice Address - Country:US
Practice Address - Phone:856-534-5246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053313001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical