Healthcare Provider Details

I. General information

NPI: 1457122749
Provider Name (Legal Business Name): BARBARA CHANNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 KINGS HWY N STE 202
CHERRY HILL NJ
08034-1907
US

IV. Provider business mailing address

1218 LANGHAM AVE
CAMDEN NJ
08103-2820
US

V. Phone/Fax

Practice location:
  • Phone: 646-204-2295
  • Fax:
Mailing address:
  • Phone: 856-571-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00955200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: