Provider Demographics
NPI:1851593982
Name:WHITE, STEPHEN GEOFFREY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GEOFFREY
Last Name:WHITE
Suffix:
Gender:M
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:PO BOX 278
Mailing Address - Street 2:70 SOUTH MAIN STREET, REAR
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-0278
Mailing Address - Country:US
Mailing Address - Phone:609-655-0420
Mailing Address - Fax:609-655-8721
Practice Address - Street 1:70 S MAIN ST STE 1C
Practice Address - Street 2:
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3140
Practice Address - Country:US
Practice Address - Phone:609-655-0420
Practice Address - Fax:609-655-8721
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04609600101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPS522186Medicare ID - Type Unspecified