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General NPI Number Information
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NPI Number | 1265030316
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Entity Type | Organization
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Legal Business Name | PENINSULA COUNSELING AND THERAPY
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 44 SYCAMORE AVE STE C
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1242
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Country | US
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Telephone | 732-241-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 44 SYCAMORE AVE STE C
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1242
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Country | US
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Telephone | 732-241-0070
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWENER
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Name | MRS. DANA M GERONI
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Credential | LPC
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Telephone | 732-241-0070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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