Healthcare Provider Details

I. General information

NPI: 1457276685
Provider Name (Legal Business Name): JESSICA STANKUS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 MAIN ST STE 4
SUCCASUNNA NJ
07876-1453
US

IV. Provider business mailing address

109 MAIN ST STE 4
SUCCASUNNA NJ
07876-1453
US

V. Phone/Fax

Practice location:
  • Phone: 908-336-1144
  • Fax:
Mailing address:
  • Phone: 908-336-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number37PC01299800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC01299800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: