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General NPI Number Information
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NPI Number | 1821496936
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Entity Type | Individual
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Provider Name | JOANNA PETRIDES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 700 MULLICA HILL RD
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City | MULLICA HILL
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State | NJ
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Zip | 08062-4413
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Country | US
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Telephone | 856-508-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 700 MULLICA HILL RD
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City | MULLICA HILL
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State | NJ
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Zip | 08062-4413
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017752
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00553000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35SI00553000
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017752
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License Number State | PA
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