Healthcare Provider Details

I. General information

NPI: 1598674608
Provider Name (Legal Business Name): STEPHANIE DE LA ROSA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 WASHINGTON ST STE A1
TOMS RIVER NJ
08753-7582
US

IV. Provider business mailing address

3101 S BRISTOL ST APT 216
SANTA ANA CA
92704-6759
US

V. Phone/Fax

Practice location:
  • Phone: 732-966-4166
  • Fax:
Mailing address:
  • Phone: 732-934-0107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06702800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: