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General NPI Number Information
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NPI Number | 1861932030
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Entity Type | Individual
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Provider Name | STEPHANIE DEROSA LPC
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Gender | Female
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 160 ATLANTIC CITY BLVD
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City | BAYVILLE
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State | NJ
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Zip | 08721-1229
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Country | US
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Telephone | 732-349-5550
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Fax |
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Provider Business Mailing Address
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Address Line | 14 AQUEDUCT PL
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City | HOWELL
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State | NJ
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Zip | 07731-2400
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Country | US
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Telephone | 732-804-3247
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00573600
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License Number State | NJ
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