MEDICARE: MS. JODY STOOTHOFF LPC LCADC CCS ACS

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	101YM0800X	Mental Health Counselor	37PC00630800	NJ
2	171M00000X	Case Manager/Care Coordinator
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	37LC00285500	NJ

General Provider Information

NPI Number	:	1386354702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODY STOOTHOFF LPC LCADC CCS ACS

Provider Business Mailing Address
First Line	:	54 GLENN TER
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-4926
Country	:	US
Telephone Number	:	856-305-5699
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 GLENN TER
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-4926
Country	:	US
Telephone Number	:	856-305-5699
Fax Number	:

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

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	03/05/2026

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