Healthcare Provider Details

I. General information

NPI: 1518254705
Provider Name (Legal Business Name): CLINT C STANKIEWICZ PSY.D., MCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BEAVER AVE
CLINTON NJ
08809-1017
US

IV. Provider business mailing address

90 BEAVER AVE
CLINTON NJ
08809-1017
US

V. Phone/Fax

Practice location:
  • Phone: 610-390-5009
  • Fax:
Mailing address:
  • Phone: 908-549-6857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: