Healthcare Provider Details

I. General information

NPI: 1124840780
Provider Name (Legal Business Name): STEPHIE DEGAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 FRONT ST
SCOTCH PLAINS NJ
07076-1103
US

IV. Provider business mailing address

265 GROVE ST APT 34
ELIZABETH NJ
07208-1652
US

V. Phone/Fax

Practice location:
  • Phone: 908-322-9180
  • Fax:
Mailing address:
  • Phone: 973-388-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00743200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: