Healthcare Provider Details

I. General information

NPI: 1285542001
Provider Name (Legal Business Name): STEPHANIE ROQUE BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 W LANDIS AVE
VINELAND NJ
08360-8132
US

IV. Provider business mailing address

423 REEVES RD
BRIDGETON NJ
08302-7228
US

V. Phone/Fax

Practice location:
  • Phone: 856-772-5809
  • Fax: 856-772-5852
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: