Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 44SL05904100 | NJ |
Y | 1041C0700X | Clinical Social Worker | 44SC05746400 | NJ |
NPI | 1003243528 |
---|---|
Provider Name | Caitlyn Stephens |
First Address | Asbury Park, NJ 07712-0959 |
Second Address | Brick, NJ 08723-6077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2013 |
Last Update Date | 23/07/2019 |