Provider Demographics
NPI:1265030316
Name:PENINSULA COUNSELING AND THERAPY
Entity Type:Organization
Organization Name:PENINSULA COUNSELING AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWENER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERONI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-241-0070
Mailing Address - Street 1:44 SYCAMORE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1242
Mailing Address - Country:US
Mailing Address - Phone:732-241-0070
Mailing Address - Fax:
Practice Address - Street 1:44 SYCAMORE AVE STE C
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1242
Practice Address - Country:US
Practice Address - Phone:732-241-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty