Provider Demographics
NPI:1023768496
Name:STAFFORD, ERNEST ALBERT JR (MSW)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:ALBERT
Last Name:STAFFORD
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 TORRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3611
Mailing Address - Country:US
Mailing Address - Phone:609-835-4429
Mailing Address - Fax:
Practice Address - Street 1:519 WEST ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3522
Practice Address - Country:US
Practice Address - Phone:856-968-2320
Practice Address - Fax:856-968-2317
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL067742001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical