Healthcare Provider Details

I. General information

NPI: 1942424874
Provider Name (Legal Business Name): CARMEN C. CENTOFANTI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GLASCOW RD
WESTAMPTON NJ
08060-2330
US

IV. Provider business mailing address

12 GLASCOW RD
WESTAMPTON NJ
08060-2330
US

V. Phone/Fax

Practice location:
  • Phone: 609-261-0259
  • Fax: 609-261-7667
Mailing address:
  • Phone: 609-261-0259
  • Fax: 609-261-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35S100155800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number35S100155800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number35S100155800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: