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General NPI Number Information
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NPI Number | 1710199559
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Entity Type | Organization
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Legal Business Name | BORDENTOWN COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 410 FARNSWORTH AVE SUITE 1A
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2005
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Country | US
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Telephone | 609-298-9144
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Fax | 609-298-9288
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Provider Business Mailing Address
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Address Line | 410 FARNSWORTH AVE SUITE 1A
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City | BORDENTOWN
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State | NJ
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Zip | 08505-2005
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Country | US
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Telephone | 609-298-9144
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Fax | 609-298-9288
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. DANA PETERSON
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Credential | LCSW
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Telephone | 609-298-9144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05197000
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License Number State | NJ
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