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General NPI Number Information
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NPI Number | 1366305294
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Entity Type | Organization
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Legal Business Name | THREE ROOTS INTEGRATIVE PSYCHIATRIC CENTER
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 403 HOOPER AVE
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City | TOMS RIVER
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State | NJ
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Zip | 08753-7701
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Country | US
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Telephone | 732-244-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 54 SAVANNAH DR
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City | BARNEGAT
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State | NJ
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Zip | 08005-1351
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Country | US
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Telephone | 732-503-5110
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | MRS. NINA THOMPSON
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Credential | APN
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Telephone | 732-503-5110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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