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General NPI Number Information
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NPI Number | 1205903549
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Entity Type | Organization
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Legal Business Name | HADDONFIELD PSYCH MANAGEMENT PA
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 TANNER STREET
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City | HADDONFIELD
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State | NJ
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Zip | 08033
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Country | US
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Telephone | 856-428-7646
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Fax | 856-216-1839
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Provider Business Mailing Address
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Address Line | 31 TANNER STREET
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City | HADDONFIELD
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State | NJ
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Zip | 08033
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Country | US
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Telephone | 856-428-7646
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Fax | 856-216-1839
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PAUL BOOKER
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Credential | PSYCHOLOGIST
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Telephone | 856-428-7646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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