Healthcare Provider Details

I. General information

NPI: 1346268505
Provider Name (Legal Business Name): STEPHEN SYLVESTER CRAIG III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 EAGLE ROCK AVE
ROSELAND NJ
07068-1353
US

IV. Provider business mailing address

157 EAGLE ROCK AVE
ROSELAND NJ
07068-1353
US

V. Phone/Fax

Practice location:
  • Phone: 973-226-8487
  • Fax:
Mailing address:
  • Phone: 973-226-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35S100260100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: