Provider Demographics
NPI:1235693367
Name:RAMESH, PRIYANKA (LAC)
Entity Type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:RAMESH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E KINGS HWY APT 309
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052-2019
Mailing Address - Country:US
Mailing Address - Phone:856-534-8149
Mailing Address - Fax:
Practice Address - Street 1:427 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-1525
Practice Address - Country:US
Practice Address - Phone:856-541-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00401700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health