Provider Demographics
NPI:1992380406
Name:STRADA, MARIE A (LSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A
Last Name:STRADA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 WARWICK TPKE
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:NJ
Mailing Address - Zip Code:07421-2816
Mailing Address - Country:US
Mailing Address - Phone:973-506-6645
Mailing Address - Fax:
Practice Address - Street 1:81 WARWICK TPKE
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:NJ
Practice Address - Zip Code:07421-2816
Practice Address - Country:US
Practice Address - Phone:973-506-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL064259001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL06425900OtherLSW LICENSE NUMBER