Healthcare Provider Details

I. General information

NPI: 1073734646
Provider Name (Legal Business Name): STEPHANIE SPARACIO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE
TRENTON NJ
08638-0000
US

IV. Provider business mailing address

321 N. PENNSYLVANIA AVE
MORRISVILLE PA
19067-0000
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax: 609-396-6024
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05338700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: