Provider Demographics
NPI:1871161356
Name:CSAKAN, STEPHANIE SARAH
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SARAH
Last Name:CSAKAN
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 1:108 TALLOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9151
Mailing Address - Country:US
Mailing Address - Phone:856-281-0105
Mailing Address - Fax:
Practice Address - Street 1:108 TALLOWOOD DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9151
Practice Address - Country:US
Practice Address - Phone:856-281-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TS0200X
NJ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool