Active NPI
Stephanie Petrucha, LCSW
- Clinical Social Worker
- Long Branch, NJ
National Provider Identifier
1497293492
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SC05557700
- Practice address
- 75 N Bath Ave
Long Branch, NJ 07740-6317 - Phone
- (732) 923-5226
- Fax
- (732) 923-5277
- NPI assigned
- Feb 9, 2017
- Last updated
- Feb 9, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC05557700 | NJ | Primary |
Addresses
Primary practice location
75 N Bath Ave
Long Branch, NJ 07740-6317
Mailing address
75 North Bath Ave
Long Branch, NJ 07740
Phone (732) 923-5226
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486598400000",
"number": "1497293492",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 NORTH BATH AVE",
"city": "LONG BRANCH",
"state": "NJ",
"postal_code": "07740",
"telephone_number": "732-923-5226",
"fax_number": "732-923-5277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 N BATH AVE",
"city": "LONG BRANCH",
"state": "NJ",
"postal_code": "077406317",
"telephone_number": "732-923-5226",
"fax_number": "732-923-5277"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUCHA",
"first_name": "STEPHANIE",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-02-09",
"last_updated": "2017-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SC05557700",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Branch, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.