Healthcare Provider Details

I. General information

NPI: 1619360237
Provider Name (Legal Business Name): NATALIE DICRESCENZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 ROUTE 70 W STE 2
CHERRY HILL NJ
08002-3338
US

IV. Provider business mailing address

2230 ROUTE 70 W STE 2
CHERRY HILL NJ
08002-3338
US

V. Phone/Fax

Practice location:
  • Phone: 856-472-9235
  • Fax:
Mailing address:
  • Phone: 856-472-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number16LP00017600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00635400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number12-077
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006896
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: