Healthcare Provider Details

I. General information

NPI: 1902408198
Provider Name (Legal Business Name): CENTER FOR RE-DISCOVERY AND GROWTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N OLDEN AVENUE EXT STE 27
EWING NJ
08618-2111
US

IV. Provider business mailing address

160 ACRES DR
HAMILTON SQUARE NJ
08690-3917
US

V. Phone/Fax

Practice location:
  • Phone: 570-872-6397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANNA MALESON
Title or Position: OWNER
Credential:
Phone: 570-872-6397