Healthcare Provider Details

I. General information

NPI: 1174281026
Provider Name (Legal Business Name): CORNERSTONE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 LINCOLN DR W STE A
MARLTON NJ
08053-1531
US

IV. Provider business mailing address

2001 LINCOLN DR W STE A
MARLTON NJ
08053-1531
US

V. Phone/Fax

Practice location:
  • Phone: 856-446-1293
  • Fax:
Mailing address:
  • Phone: 856-446-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY R. FEDERICI
Title or Position: CO-OWNER
Credential: MA, LAC
Phone: 609-420-6849