Healthcare Provider Details

I. General information

NPI: 1033397229
Provider Name (Legal Business Name): CMD MENTAL HEALTH PROFESSIONAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2008
Last Update Date: 02/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 WYNGATE RD
SOMERDALE NJ
08083-2434
US

IV. Provider business mailing address

739 WYNGATE RD
SOMERDALE NJ
08083-2434
US

V. Phone/Fax

Practice location:
  • Phone: 856-264-1717
  • Fax: 856-782-0712
Mailing address:
  • Phone: 856-264-1717
  • Fax: 856-782-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE M DUZENSKI
Title or Position: PRESIDENT/DIRECTOR
Credential: L.C.S.W.
Phone: 856-264-1717