Healthcare Provider Details

I. General information

NPI: 1033348164
Provider Name (Legal Business Name): TRACI R. STEIN PHD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TREFOIL PASS
WEST ORANGE NJ
07052-4972
US

IV. Provider business mailing address

2 TREFOIL PASS
WEST ORANGE NJ
07052-4972
US

V. Phone/Fax

Practice location:
  • Phone: 201-978-3178
  • Fax:
Mailing address:
  • Phone: 201-978-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018874
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number018874
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number018874
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: