Healthcare Provider Details

I. General information

NPI: 1407772635
Provider Name (Legal Business Name): HAILEY CRINO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S MAPLE AVE
MARLTON NJ
08053-2002
US

IV. Provider business mailing address

50 S MAPLE AVE
MARLTON NJ
08053-2002
US

V. Phone/Fax

Practice location:
  • Phone: 856-985-9091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00979100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: