Provider Demographics
NPI:1851503338
Name:STEPHENSON, YANELA G (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YANELA
Middle Name:G
Last Name:STEPHENSON
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:P. O. BOX 1713
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08903-1713
Mailing Address - Country:US
Mailing Address - Phone:732-246-8596
Mailing Address - Fax:732-246-1429
Practice Address - Street 1:700 EASTON AVENUE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1820
Practice Address - Country:US
Practice Address - Phone:732-246-8596
Practice Address - Fax:732-246-1429
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002693001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ959150Medicare PIN