Healthcare Provider Details

I. General information

NPI: 1528274776
Provider Name (Legal Business Name): FAMILY & PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1868 GREENTREE RD
CHERRY HILL NJ
08003-2031
US

IV. Provider business mailing address

1868 GREENTREE RD
CHERRY HILL NJ
08003
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-4408
  • Fax: 856-424-9164
Mailing address:
  • Phone: 856-424-4408
  • Fax: 856-424-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: IRIS NEGRON
Title or Position: BILLING MANAGER
Credential:
Phone: 856-424-4408