Provider Demographics
NPI:1124840780
Name:DEGAND, STEPHIE
Entity type:Individual
Prefix:
First Name:STEPHIE
Middle Name:
Last Name:DEGAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 GROVE ST APT 34
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1652
Mailing Address - Country:US
Mailing Address - Phone:973-388-5908
Mailing Address - Fax:
Practice Address - Street 1:1830 FRONT ST
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1103
Practice Address - Country:US
Practice Address - Phone:908-322-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00743200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health