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General NPI Number Information
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NPI Number | 1902408198
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Entity Type | Organization
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Legal Business Name | CENTER FOR RE-DISCOVERY AND GROWTH LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 1901 N OLDEN AVENUE EXT STE 27
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City | EWING
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State | NJ
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Zip | 08618-2111
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Country | US
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Telephone | 570-872-6397
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Fax |
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Provider Business Mailing Address
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Address Line | 160 ACRES DR
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City | HAMILTON SQUARE
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State | NJ
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Zip | 08690-3917
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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 | OWNER
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Name | ANNA MALESON
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Credential |
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Telephone | 570-872-6397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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