Healthcare Provider Details

I. General information

NPI: 1528721651
Provider Name (Legal Business Name): JERI FATIA MENTOR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PERRY ST
TRENTON NJ
08618-3968
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 609-394-8988
  • Fax: 609-394-0023
Mailing address:
  • Phone: 732-908-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number37LC00328700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00867400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: