Provider Demographics
NPI:1134721202
Name:KINNEY, STEPHANIE (LAC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KINNEY
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 1:3 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1513
Mailing Address - Country:US
Mailing Address - Phone:856-816-8531
Mailing Address - Fax:
Practice Address - Street 1:1 S BROAD ST STE 3B
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-4609
Practice Address - Country:US
Practice Address - Phone:856-693-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00448900101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor