Healthcare Provider Details

I. General information

NPI: 1407717960
Provider Name (Legal Business Name): THE CENTER FOR CLINICAL TRAINING AND PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BAY AVE STE 108
SOMERS POINT NJ
08244-2554
US

IV. Provider business mailing address

109 CAROL RD
LINWOOD NJ
08221-2501
US

V. Phone/Fax

Practice location:
  • Phone: 609-287-2559
  • Fax:
Mailing address:
  • Phone: 609-287-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. GINA INNOCENTE
Title or Position: HEAD OF PRACTICE
Credential: DSW, LCSW
Phone: 609-287-2559