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General NPI Number Information
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NPI Number | 1578337150
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Entity Type | Individual
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Provider Name | STEPHANIE SHANTE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 10 GREEN ST APT 218 218
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3364
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Country | US
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Telephone | 646-397-7460
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Fax |
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Provider Business Mailing Address
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Address Line | 10 GREEN ST APT 218
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3364
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Country | US
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Telephone | 646-397-7460
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Fax |
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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