Provider Demographics
NPI:1275927352
Name:AVENT-PRICE, CHERYL LOUISE
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LOUISE
Last Name:AVENT-PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109
Mailing Address - Country:US
Mailing Address - Phone:856-488-1982
Mailing Address - Fax:856-488-1982
Practice Address - Street 1:130 TIFFANY LANE
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046
Practice Address - Country:US
Practice Address - Phone:609-670-2174
Practice Address - Fax:856-488-1482
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJCSW44SW00224100104100000X
171M00000X, 261QD1600X, 373H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child