Stephanie Bourgeois, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05195100 Issued in NJ

Practice address

15 Village PLZ Ste 2B
South Orange, NJ 07079-2800

Phone

(973) 275-6262

NPI assigned

Apr 11, 2007

Last updated

Aug 23, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 25, 2025 through May 25, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Summit Psychological Services PA

  • Psychologist
  • Summit, NJ
  • NPI 1992893317
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598140800000",
    "number": "1518180108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VILLAGE PLZ STE 2B",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792800",
            "telephone_number": "973-275-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 VILLAGE PLZ STE 2B",
            "city": "SOUTH ORANGE",
            "state": "NJ",
            "postal_code": "070792800",
            "telephone_number": "973-275-6262"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 Summit Avenue",
            "address_purpose": "LOCATION",
            "city": "Summit",
            "state": "NJ",
            "postal_code": "079013613",
            "country_code": "US",
            "telephone_number": "908-273-5558",
            "fax_number": "908-273-8811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOURGEOIS",
        "first_name": "STEPHANIE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-23",
        "certification_date": "2020-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05195100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abby J Beutel, FNP
• Bgaw Treatment
• Big Apple Medical Services
• Kiki Tamika Black, MSW
• Estefania Amanda Bonavera, MD
• Tiffani Branch, BCBA
• Jennifer Lauren Breuninger
• Frederick F Buechel Sr., MD
• Irene Burak
• John Burger, D.O.

• Clinical Social Worker in South Orange, NJ
• Providers in South Orange, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.