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General NPI Number Information
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NPI Number | 1790468569
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Entity Type | Individual
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Provider Name | STACEY KEANE BODEN LICSW
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Gender | Female
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 3458 NEELY RD
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City | MC GUIRE AFB
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State | NJ
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Zip | 08641-5312
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Country | US
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Telephone | 866-377-2778
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Fax |
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Provider Business Mailing Address
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Address Line | 101 VILLINGER AVE
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City | CINNAMINSON
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State | NJ
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Zip | 08077-2911
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Country | US
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Telephone | 757-289-2947
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC06491300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5267C-S
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License Number State | AL
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