Provider Demographics
NPI:1588931083
Name:SAMMARCO, STEPHANIE (MA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:SAMMARCO
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MENLO PARK STE 2052
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2428
Mailing Address - Country:US
Mailing Address - Phone:908-858-5270
Mailing Address - Fax:
Practice Address - Street 1:100 MENLO PARK STE 2052
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2428
Practice Address - Country:US
Practice Address - Phone:908-858-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
DEPC0000706101YM0800X
NJ37PC00521000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor