Provider Demographics
NPI:1629809470
Name:CLEARSTEP THERAPY LLC
Entity type:Organization
Organization Name:CLEARSTEP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHCHERBAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA
Authorized Official - Phone:609-436-0193
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-0012
Mailing Address - Country:US
Mailing Address - Phone:609-436-0193
Mailing Address - Fax:
Practice Address - Street 1:199 6TH AVE STE A2
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9749
Practice Address - Country:US
Practice Address - Phone:609-436-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty