Healthcare Provider Details

I. General information

NPI: 1619960374
Provider Name (Legal Business Name): JULIA THERESA STAHL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 ROSEBERRY STREET STE 9
PHILLIPSBURG NJ
08865
US

IV. Provider business mailing address

305 ROSEBERRY STREET STE 9
PHILLIPSBURG NJ
08865
US

V. Phone/Fax

Practice location:
  • Phone: 908-619-7334
  • Fax: 908-387-4275
Mailing address:
  • Phone: 908-619-7334
  • Fax: 908-387-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021209
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0011883
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04545900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: