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NPI Code Detail

MEDICARE: DONNA DISTEFANO LCSW. LCADC

MEDICARE: DONNA DISTEFANO LCSW. 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
11041C0700XClinical Social Worker44SC05181100NJ
2101YA0400XAddiction (Substance Use Disorder) Counselor37LC00123500NJ
31041C0700XClinical Social Worker101276-01NY

General Provider Information

NPI Number : 1760560049
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA DISTEFANO LCSW. LCADC
Provider Business Mailing Address
First Line : 328 DENISON ST
Second Line :
City : HIGHLAND PARK
State : NJ
Zip : 08904-2732
Country : US
Telephone Number : 732-266-5154
Fax Number :
Provider Business Practice Location Address
First Line : 328 DENISON ST
Second Line :
City : HIGHLAND PARK
State : NJ
Zip : 08904-2732
Country : US
Telephone Number : 732-266-5151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 02/11/2026

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