Provider Demographics
NPI:1316084254
Name:STAVOLA, JOANNE C (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:C
Last Name:STAVOLA
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1717
Mailing Address - Country:US
Mailing Address - Phone:732-933-0803
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07739
Practice Address - Country:US
Practice Address - Phone:732-403-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05300800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health