Provider Demographics
NPI:1164945440
Name:MAJETTE, TISHANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TISHANNA
Middle Name:
Last Name:MAJETTE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 ATRIUM WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3909
Mailing Address - Country:US
Mailing Address - Phone:856-522-3123
Mailing Address - Fax:
Practice Address - Street 1:3000 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-522-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2020-12-01
Deactivation Date:2018-05-28
Deactivation Code:
Reactivation Date:2018-06-27
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00581600103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty