Healthcare Provider Details

I. General information

NPI: 1003267220
Provider Name (Legal Business Name): DEEPANJALI TIWARI LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 VILLAGE BLVD STE 200 #2892
PRINCETON NJ
08540-5700
US

IV. Provider business mailing address

116 VILLAGE BLVD STE 200 #2892
PRINCETON NJ
08540-5700
US

V. Phone/Fax

Practice location:
  • Phone: 908-800-2225
  • Fax:
Mailing address:
  • Phone: 908-800-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: