Provider Demographics
NPI:1225241995
Name:CENTRA PC
Entity Type:Organization
Organization Name:CENTRA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-985-3030
Mailing Address - Street 1:5000 SAGEMORE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 SAGEMORE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4307
Practice Address - Country:US
Practice Address - Phone:856-985-3030
Practice Address - Fax:856-985-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCE883152101YM0800X
PACE883152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCE883152OtherGROUP NUMBER