Provider Demographics
NPI:1881745727
Name:DESTEFANO-TORRES, KATHERINE RACHEL (LPC)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:RACHEL
Last Name:DESTEFANO-TORRES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 FRIES MILL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2016
Mailing Address - Country:US
Mailing Address - Phone:856-589-3420
Mailing Address - Fax:856-345-2820
Practice Address - Street 1:151 FRIES MILL RD STE 301
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-589-3420
Practice Address - Fax:856-345-2820
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00304400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ791234000OtherMAGELLAN
NJ2400866000OtherAMERIHEALTH