Healthcare Provider Details

I. General information

NPI: 1306079066
Provider Name (Legal Business Name): LAUREN STELLA FAFULAS MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD ROOM 200A, 116D
LYONS NJ
07939-5001
US

IV. Provider business mailing address

151 KNOLLCROFT RD ROOM 200A, 116D
LYONS NJ
07939-5001
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5886
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-604-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05569200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: