Healthcare Provider Details

I. General information

NPI: 1578337150
Provider Name (Legal Business Name): STEPHANIE SHANTE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GREEN ST APT 218 218
WOODBRIDGE NJ
07095-3364
US

IV. Provider business mailing address

10 GREEN ST APT 218
WOODBRIDGE NJ
07095-3364
US

V. Phone/Fax

Practice location:
  • Phone: 646-397-7460
  • Fax:
Mailing address:
  • Phone: 646-397-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: