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General NPI Number Information
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NPI Number | 1760912661
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Entity Type | Organization
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Legal Business Name | RED OAK PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 100 HADDONTOWNE CT
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3602
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Country | US
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Telephone | 609-504-2522
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Fax | 856-427-0089
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Provider Business Mailing Address
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Address Line | 376 FORK BRIDGE RD
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City | PITTSGROVE
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State | NJ
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Zip | 08318-4527
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Country | US
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Telephone | 609-504-2522
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JANET A CASTELLINI
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Credential | LCSW LCADC
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Telephone | 609-504-2522
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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 | CW016387
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05428100
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License Number State | NJ
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