1831330653 NPI number — CONTEXTUAL FAMILY THERAPY OF SOUTH JERSEY

Table of content: (NPI 1831330653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831330653 NPI number — CONTEXTUAL FAMILY THERAPY OF SOUTH JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTEXTUAL FAMILY THERAPY OF SOUTH JERSEY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831330653
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
49 SAINT MIHIEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08075-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-781-0441
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 S BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-4655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-853-9300
Provider Business Practice Location Address Fax Number:
856-461-5513
Provider Enumeration Date:
03/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
COWAN
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
A. HULSE
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-781-0441

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  37FI00148600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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