Healthcare Provider Details

I. General information

NPI: 1639962558
Provider Name (Legal Business Name): STACEY COLFER BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 AIRPORT RD STE 7G
LAKEWOOD NJ
08701-5968
US

IV. Provider business mailing address

PO BOX 2036
LAKEWOOD NJ
08701-8036
US

V. Phone/Fax

Practice location:
  • Phone: 732-276-1510
  • Fax: 732-363-5537
Mailing address:
  • Phone: 732-276-1510
  • Fax: 732-363-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: