Peter Staller, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05544900 Issued in NJ

Practice address

515 Wyckoff Ave
Wyckoff, NJ 07481-1232

Phone

(917) 742-5263

NPI assigned

Dec 13, 2022

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1962113704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 WYCKOFF AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811232",
            "telephone_number": "917-742-5263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 WYCKOFF AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811232",
            "telephone_number": "917-742-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLER",
        "first_name": "PETER",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-13",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05544900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin L Smithline, MD
• Manal Ann Sous, MD
• Dianne Speakman, SLP.
• Shannon Catherine Spurrell, OTD, OTR/L
• Shannon Stahler
• Mark A. Stansfield, PA-C
• Tanvi S. Stansfield, PA-C
• Renee Remy Stefanacci, MA-SLP, CCC
• Frederick Steinberg, MD
• Lance Stern

• Clinical Social Worker in Wyckoff, NJ
• Providers in Wyckoff, 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 Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.