Individual provider Active NPI

Stephanie Dizenzo-Priestley, PHD, LPC

  • Mental Health Counselor
  • Freehold, NJ
National Provider Identifier
1760983902
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
37PC00703000 Issued in NJ
Practice address
2 Paragon Way Ste 800
Freehold, NJ 07728-9573
Phone
(732) 393-8391
Fax
(732) 561-1721
NPI assigned
Feb 22, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 37PC00703000 NJ Primary

Addresses

Primary practice location

2 Paragon Way Ste 800
Freehold, NJ 07728-9573

Mailing address

2 Paragon Way Ste 800
Freehold, NJ 07728-9573
Phone (732) 393-8391

Other practice location 1

5 Vaughn Dr Ste 108
Princeton, NJ 08540-6313
Phone (732) 393-8391

Other identifiers 1

IdentifierTypeStateIssuer
0029807MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250107001586 NJ Practitioner - Mental Health Counselor 6608304472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tree of Life Counseling Center, LLCGroup PAC ID 2668848425, 9 clinicians

Practice addresses (Care Compare)

2 Paragon Way
Suite 800
Freehold, NJ 07728-9573
Phone (732) 393-8391

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
37PC00703000NJMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Tree of Life Counseling Center, LLC Mental Health CurrentSince Nov 4, 2024 Accepting new patients

Locations

2 Paragon Way
Ste 800
Freehold, NJ 07728
Phone (732) 393-8391

5 Vaughn Dr
Ste 108
Princeton, NJ 08540
Phone (732) 393-8391

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1760983902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PARAGON WAY STE 800",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077289573",
            "telephone_number": "732-393-8391",
            "fax_number": "732-561-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PARAGON WAY STE 800",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077289573",
            "telephone_number": "732-393-8391",
            "fax_number": "732-561-1721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Vaughn Dr Ste 108",
            "address_purpose": "LOCATION",
            "city": "Princeton",
            "state": "NJ",
            "postal_code": "085406313",
            "country_code": "US",
            "telephone_number": "732-393-8391",
            "fax_number": "732-561-1721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIZENZO-PRIESTLEY",
        "first_name": "STEPHANIE",
        "name_prefix": "Dr.",
        "credential": "PHD, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-22",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "37PC00703000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0029807",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

Verify at the official NPI Registry.