Provider Demographics
NPI:1487177101
Name:STEPHANIE IANNELLI LCSW LLC
Entity type:Organization
Organization Name:STEPHANIE IANNELLI LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:848-251-2642
Mailing Address - Street 1:250 WASHINGTON ST STE A2
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7575
Mailing Address - Country:US
Mailing Address - Phone:848-251-2642
Mailing Address - Fax:848-251-2641
Practice Address - Street 1:250 WASHINGTON STREET
Practice Address - Street 2:SUITE A2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:848-251-2642
Practice Address - Fax:848-251-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05660900261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)