Provider Demographics
NPI:1073766341
Name:CRANBURY THERAPY LLC
Entity Type:Organization
Organization Name:CRANBURY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S.
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-655-0420
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:70 SOUTH MAIN STREET, SUITE 1C
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512-0155
Mailing Address - Country:US
Mailing Address - Phone:609-655-0420
Mailing Address - Fax:609-655-8721
Practice Address - Street 1:70 S MAIN ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:CRANBURY
Practice Address - State:NJ
Practice Address - Zip Code:08512-3140
Practice Address - Country:US
Practice Address - Phone:609-655-0420
Practice Address - Fax:609-655-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04609600261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PS522186Medicare PIN