=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053574368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRINCETON HOUSE BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2008
-----------------------------------------------------
Last Update Date | 07/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 NORTH KINGS HIGHWAY
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08034-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-779-2300
-----------------------------------------------------
Fax | 856-779-2988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 375 N KINGS HWY
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08034-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-779-2300
-----------------------------------------------------
Fax | 856-779-2988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL COORDINATOR
-----------------------------------------------------
Name | MS. ANDREA LOPRESTI
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 856-779-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 931740303
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------