Provider Demographics
NPI:1003639980
Name:DE LELLIS, STEPHANIE (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:DE LELLIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-4352
Mailing Address - Country:US
Mailing Address - Phone:732-610-3109
Mailing Address - Fax:
Practice Address - Street 1:2901 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-4352
Practice Address - Country:US
Practice Address - Phone:732-610-3109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00667100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health