Healthcare Provider Details

I. General information

NPI: 1760912661
Provider Name (Legal Business Name): RED OAK PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HADDONTOWNE CT
CHERRY HILL NJ
08034-3602
US

IV. Provider business mailing address

376 FORK BRIDGE RD
PITTSGROVE NJ
08318-4527
US

V. Phone/Fax

Practice location:
  • Phone: 609-504-2522
  • Fax: 856-427-0089
Mailing address:
  • Phone: 609-504-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW016387
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05428100
License Number StateNJ

VIII. Authorized Official

Name: JANET A CASTELLINI
Title or Position: MEMBER
Credential: LCSW LCADC
Phone: 609-504-2522