MEDICARE: STEPHANIE MANFREDI LCADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1679399935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MANFREDI LCADC

Provider Business Mailing Address
First Line	:	121 DRUM POINT RD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6221
Country	:	US
Telephone Number	:	732-278-9538
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 DRUM POINT RD
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-6221
Country	:	US
Telephone Number	:	732-278-9538
Fax Number	:

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

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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