| Doctor Name: | MR. JAMES MICHAEL DESTEFANO |
| NPI Number: | 1104029099 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S.W. ,L.S.W. |
| License Number: | 44SL05036200 |
| Business Practice Address: | 720 King George Rd Fords, NJ - 088631974 |
| Business Phone Number: | 7327384209 |
| Business Fax Number: | 7327384208 |
| Mailing Address: | 4 Harbor Ct, MONROE TOWNSHIP |
| State: | NJ |
| Postal Code: | 088311697 |
| Phone Number: | 7328871530 |
| Fax Number: | 7327384208 |
| NPI Enumeration Date: | 06/07/2007 |
| NPI Last Update Date: | 07/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 44SL05036200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |