Provider Demographics
NPI:1720662273
Name:MUSTO, STEFANIE (LCSW)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:MUSTO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 CALUMET ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1750
Mailing Address - Country:US
Mailing Address - Phone:516-425-2881
Mailing Address - Fax:
Practice Address - Street 1:610 OLD YORK ROAD
Practice Address - Street 2:438
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19129
Practice Address - Country:US
Practice Address - Phone:267-538-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0217621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical