Healthcare Provider Details

I. General information

NPI: 1366305294
Provider Name (Legal Business Name): THREE ROOTS INTEGRATIVE PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 HOOPER AVE
TOMS RIVER NJ
08753-7701
US

IV. Provider business mailing address

54 SAVANNAH DR
BARNEGAT NJ
08005-1351
US

V. Phone/Fax

Practice location:
  • Phone: 732-244-7700
  • Fax:
Mailing address:
  • Phone: 732-503-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NINA THOMPSON
Title or Position: PMHNP
Credential: APN
Phone: 732-503-5110