Provider Demographics
NPI:1699242057
Name:AHERN, STEPHEN RICHARD
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RICHARD
Last Name:AHERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MIDDLESEX AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1352
Mailing Address - Country:US
Mailing Address - Phone:215-840-1499
Mailing Address - Fax:
Practice Address - Street 1:8 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1352
Practice Address - Country:US
Practice Address - Phone:609-534-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00374400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor