=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619234226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN REED GERALD CSW, CPE, MDIV
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2012
-----------------------------------------------------
Last Update Date | 08/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 SCHALKS CROSSING RD
-----------------------------------------------------
City | PLAINSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08536-1613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-915-4499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 ADIRONDAK RD
-----------------------------------------------------
City | BORDENTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08505-4457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-915-4499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP1600X
-----------------------------------------------------
Taxonomy Name | Pastoral Counselor
-----------------------------------------------------
License Number | CPE
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SW00969100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------