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NPI Code Detail

MEDICARE: STEFANIE GAUDIO MSW, LSW

MEDICARE: STEFANIE GAUDIO MSW, LSW
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
1104100000XSocial Worker44SL06569500NJ

General Provider Information

NPI Number : 1154933679
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFANIE GAUDIO MSW, LSW
Provider Business Mailing Address
First Line : 333 W ADAMS AVE
Second Line :
City : MAGNOLIA
State : NJ
Zip : 08049-1709
Country : US
Telephone Number : 631-327-5940
Fax Number :
Provider Business Practice Location Address
First Line : 1103 SHEPPARD RD
Second Line :
City : VOORHEES
State : NJ
Zip : 08043-4797
Country : US
Telephone Number : 856-625-6550
Fax Number : 856-409-0991
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2020
Last Update Date : 08/17/2020

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