Provider Demographics
NPI:1174281026
Name:CORNERSTONE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CORNERSTONE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FEDERICI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAC
Authorized Official - Phone:609-420-6849
Mailing Address - Street 1:2001 LINCOLN DR W STE A
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1531
Mailing Address - Country:US
Mailing Address - Phone:856-446-1293
Mailing Address - Fax:
Practice Address - Street 1:2001 LINCOLN DR W STE A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1531
Practice Address - Country:US
Practice Address - Phone:856-446-1293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1255094082OtherANTHONY FEDERICI
NJ1841954161OtherNICOLE KOZAK
NJ1013118827OtherROBERT HAYNES