Healthcare Provider Details

I. General information

NPI: 1285558460
Provider Name (Legal Business Name): TENISHA PERCELL LCSW
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

PO BOX 28289
NEWARK NJ
07101-2484
US

IV. Provider business mailing address

PO BOX 28289
NEWARK NJ
07101-2484
US

V. Phone/Fax

Practice location:
  • Phone: 470-868-0986
  • Fax:
Mailing address:
  • Phone: 470-868-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW04570
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: