Provider Demographics
NPI:1164267852
Name:VARELA, STEPHANIE ALLISON
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:VARELA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FARNHAM AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1305
Mailing Address - Country:US
Mailing Address - Phone:973-861-6499
Mailing Address - Fax:
Practice Address - Street 1:95 FARNHAM AVE APT 1
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1305
Practice Address - Country:US
Practice Address - Phone:973-861-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07097600104100000X
NY123673104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker