Healthcare Provider Details

I. General information

NPI: 1265193825
Provider Name (Legal Business Name): INSPIRING SYNAPSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 01/06/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 INDEPENDENCE BLVD
SICKLERVILLE NJ
08081-1093
US

IV. Provider business mailing address

305 INDEPENDENCE BLVD
SICKLERVILLE NJ
08081-1093
US

V. Phone/Fax

Practice location:
  • Phone: 609-365-0712
  • Fax: 609-904-2265
Mailing address:
  • Phone: 609-365-0712
  • Fax: 609-904-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY WAYNE COX JR.
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LPC, LCADC, ACS
Phone: 609-365-0712