Healthcare Provider Details

I. General information

NPI: 1962357822
Provider Name (Legal Business Name): STEPHANIE KOSTOLANSKY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 MORRIS TPKE STE 210
SHORT HILLS NJ
07078-2617
US

IV. Provider business mailing address

748 MORRIS TPKE STE 210
SHORT HILLS NJ
07078-2617
US

V. Phone/Fax

Practice location:
  • Phone: 848-391-2809
  • Fax: 973-588-3212
Mailing address:
  • Phone: 848-391-2809
  • Fax: 973-588-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01225700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: