=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437366606
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. RONNIE PHYLLIS STERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 169 MAPLEWOOD AVE SUITE 1
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07040-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-762-6800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 HICKORY DRIVE
-----------------------------------------------------
City | MAPLEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07040-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-762-0289
-----------------------------------------------------
Fax | 973-762-2962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 37FI00139500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------