Provider Demographics
NPI:1700605482
Name:STERN, DANIEL S (LSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:STERN
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 ASHLAND AVE APT A45
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2436
Mailing Address - Country:US
Mailing Address - Phone:908-227-9623
Mailing Address - Fax:
Practice Address - Street 1:209 COOPER AVE STE 112
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1883
Practice Address - Country:US
Practice Address - Phone:201-719-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07106200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker