Provider Demographics
NPI:1376756577
Name:PENNSVILLE COUNSELING ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:PENNSVILLE COUNSELING ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:CARRERE
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-467-1000
Mailing Address - Street 1:545 BECKETT RD STE 207
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1512
Mailing Address - Country:US
Mailing Address - Phone:856-467-1000
Mailing Address - Fax:856-467-1150
Practice Address - Street 1:545 BECKETT RD STE 207
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1512
Practice Address - Country:US
Practice Address - Phone:856-467-1000
Practice Address - Fax:856-467-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ073393OtherPTAN
NJ073393OtherPTAN