Healthcare Provider Details

I. General information

NPI: 1871308213
Provider Name (Legal Business Name): STEPHANIE MICHELLE PUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MARSHALLVILLE RD
WOODBINE NJ
08270-3323
US

IV. Provider business mailing address

280 MARSHALLVILLE RD
WOODBINE NJ
08270-3323
US

V. Phone/Fax

Practice location:
  • Phone: 609-224-0640
  • Fax:
Mailing address:
  • Phone: 609-224-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05407300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: