Healthcare Provider Details

I. General information

NPI: 1831004803
Provider Name (Legal Business Name): CASEY TIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY PKWY STE 250
MOUNT LAUREL NJ
08054-1149
US

IV. Provider business mailing address

1314 MORGAN CT E
JACKSON NJ
08527-3210
US

V. Phone/Fax

Practice location:
  • Phone: 201-256-1456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: