Provider Demographics
NPI:1174958219
Name:MAKOW, STEPHANIE (LSW)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MAKOW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LACEY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-2200
Mailing Address - Country:US
Mailing Address - Phone:609-242-3322
Mailing Address - Fax:
Practice Address - Street 1:615 LACEY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2200
Practice Address - Country:US
Practice Address - Phone:609-242-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05910300104100000X
NJ9024121041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool