Healthcare Provider Details

I. General information

NPI: 1649134826
Provider Name (Legal Business Name): PAIGE PORTNER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 KINGSWOOD PL
CLEMENTON NJ
08021-5809
US

IV. Provider business mailing address

1701 KINGSWOOD PL
CLEMENTON NJ
08021-5809
US

V. Phone/Fax

Practice location:
  • Phone: 609-354-2364
  • Fax:
Mailing address:
  • Phone: 609-354-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06958800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: