Healthcare Provider Details

I. General information

NPI: 1861544629
Provider Name (Legal Business Name): COUNSELING AND PSYCHOTHERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RED LION RD SUITE D
SOUTHAMPTON NJ
08088-8830
US

IV. Provider business mailing address

3 SAINT MICHAELS CT
SOUTHAMPTON NJ
08088-3525
US

V. Phone/Fax

Practice location:
  • Phone: 609-801-9555
  • Fax: 609-801-9008
Mailing address:
  • Phone: 609-801-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05000
License Number StateNJ

VIII. Authorized Official

Name: MS. CYNTHIA D PINE
Title or Position: LICENSED PSYCHOTHERAPIST
Credential: MSW, LCSW, BCETS
Phone: 609-801-9008