Provider Demographics
NPI:1720355282
Name:DENAFO, STACEY NADINE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:NADINE
Last Name:DENAFO
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Gender:F
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:2300 NEW RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1466
Mailing Address - Country:US
Mailing Address - Phone:609-407-7117
Mailing Address - Fax:609-407-7110
Practice Address - Street 1:2300 NEW RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1466
Practice Address - Country:US
Practice Address - Phone:609-407-7117
Practice Address - Fax:609-407-7110
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2012-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJYS03200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10654772OtherCAQH
1669747549OtherNPI TYPE II