Healthcare Provider Details

I. General information

NPI: 1194541623
Provider Name (Legal Business Name): SERENITY HEALTH OF NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MARTER AVE STE 301
MOORESTOWN NJ
08057-3124
US

IV. Provider business mailing address

110 MARTER AVE STE 301
MOORESTOWN NJ
08057-3124
US

V. Phone/Fax

Practice location:
  • Phone: 856-208-6217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA JEANNE BEARD
Title or Position: OWNER
Credential: APN
Phone: 856-298-7554