Provider Demographics
NPI:1871318253
Name:POLO, STEPHANIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIA
Middle Name:
Last Name:POLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MILLBURN AVE UNIT 139
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-4308
Mailing Address - Country:US
Mailing Address - Phone:201-844-1270
Mailing Address - Fax:
Practice Address - Street 1:1501 HAMBURG TPKE STE 2
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4032
Practice Address - Country:US
Practice Address - Phone:862-684-8484
Practice Address - Fax:862-904-8007
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00894500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health