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General NPI Number Information
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NPI Number | 1104029099
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Entity Type | Individual
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Provider Name | JAMES MICHAEL DESTEFANO M.S.W. ,L.S.W.
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Gender | Male
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 720 KING GEORGE RD
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City | FORDS
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State | NJ
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Zip | 08863-1974
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Country | US
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Telephone | 732-738-4209
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Fax | 732-738-4208
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Provider Business Mailing Address
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Address Line | 4 HARBOR CT
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-1697
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Country | US
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Telephone | 732-887-1530
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Fax | 732-738-4208
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SL05036200
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License Number State | NJ
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