Basic Information
| Provider Information | |||||||||
| NPI: | 1700278355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CEDENO | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 WILCOX ST | ||||||||
| Address2: | |||||||||
| City: | DUMONT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076283113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019839625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 LINCOLN BLVD | ||||||||
| Address2: | |||||||||
| City: | EMERSON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076301038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1111111111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2015 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.