Basic Information
| Provider Information | |||||||||
| NPI: | 1265546089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHEN | ||||||||
| FirstName: | ANTONY | ||||||||
| MiddleName: | PITCHAI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW, PH.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8103 WARRENS WAY | ||||||||
| Address2: | |||||||||
| City: | WANAQUE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074651609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957037 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 TREMONT AVE | ||||||||
| Address2: | |||||||||
| City: | EAST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070181023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736761000 | ||||||||
| FaxNumber: | 9733957037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SC00856000 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.