Provider Demographics
NPI:1023721321
Name:WILLOUGHBY, STEPHANIE LORETTA (LCSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LORETTA
Last Name:WILLOUGHBY
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08855-0154
Mailing Address - Country:US
Mailing Address - Phone:732-261-3513
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 154
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08855-0154
Practice Address - Country:US
Practice Address - Phone:732-261-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT137921041C0700X
ORL150861041C0700X
WALW.615192091041C0700X
NJ44SC061492001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical