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General NPI Number Information
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NPI Number | 1295006344
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC ASSOCIATES OF SOUTHERN NJ
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Dates
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Enumeration Date | 01/21/2012
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Last Update Date | 01/21/2012
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Provider Practice Location Address
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Address Line | 188 FRIES MILL RD SUITE E3
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City | TURNERSVILLE
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State | NJ
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Zip | 08012-2015
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Country | US
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Telephone | 856-885-8036
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Fax |
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Provider Business Mailing Address
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Address Line | 2 GOSLING CT
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-4882
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | APN
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Name | EBONI FREEMAN
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Credential | MSN, APN-BC
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Telephone | 856-885-8036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 26NJ00332200
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License Number State | NJ
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