MEDICARE: MR. ERNEST ALBERT STAFFORD JR. MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SL06774200	NJ

General Provider Information

NPI Number	:	1023768496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERNEST ALBERT STAFFORD JR. MSW

Provider Business Mailing Address
First Line	:	103 TORRINGTON LN
Second Line	:
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-3611
Country	:	US
Telephone Number	:	609-835-4429
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 WEST ST
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-3522
Country	:	US
Telephone Number	:	856-968-2320
Fax Number	:	856-968-2317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	03/28/2022

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