1912124942 NPI number — MRS. SHELLEY ELIZABETH STAHL I MSW,LCSW

Table of content: MRS. SHELLEY ELIZABETH STAHL I MSW,LCSW (NPI 1912124942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912124942 NPI number — MRS. SHELLEY ELIZABETH STAHL I MSW,LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAHL
Provider First Name:
SHELLEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
I
Provider Credential Text:
MSW,LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912124942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 MASTERS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-983-5487
Provider Business Mailing Address Fax Number:
856-797-6983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 KINGS HWY E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HADDONFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08033-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-797-1370
Provider Business Practice Location Address Fax Number:
856-797-6983
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC04675400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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