Healthcare Provider Details

I. General information

NPI: 1952906190
Provider Name (Legal Business Name): CENTER FOR AFRICAN AMERICAN HEALTH DISPARITIES EDUCATION & RESEARCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N HARTFORD AVE SUITE 7
ATLANTIC CITY NJ
08401-3547
US

IV. Provider business mailing address

125 N HARTFORD AVE SUITE 7
ATLANTIC CITY NJ
08401-3547
US

V. Phone/Fax

Practice location:
  • Phone: 609-802-8476
  • Fax:
Mailing address:
  • Phone: 609-802-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER WARREN
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, CCP
Phone: 609-802-8476