MEDICARE: MR. JOHN ANTHONY DESTEFANO JR. 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
1	104100000X	Social Worker	44SL06987700	NJ

General Provider Information

NPI Number	:	1497689079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ANTHONY DESTEFANO JR. LSW

Provider Business Mailing Address
First Line	:	415 LAWRENCE DR
Second Line	:
City	:	LANOKA HARBOR
State	:	NJ
Zip	:	08734-2515
Country	:	US
Telephone Number	:	732-814-3836
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 ROUTE 88
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-2320
Country	:	US
Telephone Number	:	732-785-1900
Fax Number	:

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

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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