Healthcare Provider Details

I. General information

NPI: 1447525597
Provider Name (Legal Business Name): GREATER TRENTON BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 BRUNSWICK PIKE
LAWRENCEVILLE NJ
08648-4103
US

IV. Provider business mailing address

8 MERSHON LN
PLAINSBORO NJ
08536-1123
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax: 609-396-6024
Mailing address:
  • Phone: 609-799-6472
  • Fax: 609-396-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37PC00426300
License Number StateNJ

VIII. Authorized Official

Name: MRS. JENINE MICHELE BLOUNT
Title or Position: THERAPIST
Credential: LPC
Phone: 609-396-8877