Healthcare Provider Details

I. General information

NPI: 1326533449
Provider Name (Legal Business Name): STEPHANIE MARIE IGLESIAS LSW, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 ROSEMONT AVE
NEWFIELD NJ
08344-5238
US

IV. Provider business mailing address

677 ROSEMONT AVE
NEWFIELD NJ
08344-5238
US

V. Phone/Fax

Practice location:
  • Phone: 856-300-9308
  • Fax:
Mailing address:
  • Phone: 856-300-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06357800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: