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General NPI Number Information
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NPI Number | 1952418691
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Entity Type | Individual
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Provider Name | STEPHANIE B CADDO LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1250 E RIDGEWOOD AVENUE SUITE 10
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City | RIDGEWOOD
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State | NJ
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Zip | 07450
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Country | US
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Telephone | 201-615-5909
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Fax | 201-848-8686
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Provider Business Mailing Address
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Address Line | 373 WILDWOOD AVENUE
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City | FRANKLIN LAKES
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State | NJ
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Zip | 07417
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Country | US
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Telephone | 201-848-1115
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Fax | 201-848-8686
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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 | 44SC04556000
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License Number State | NJ
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