Provider Demographics
NPI:1265534655
Name:NEUSTADTER, STEFAN SHEPARD (MSW)
Entity type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:SHEPARD
Last Name:NEUSTADTER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:BRANCA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:279 HAMILTON PLACE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 KNOLLCROFT ROAD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00757600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health