Provider Demographics
NPI:1437716305
Name:THORN, BRENDA C (LAC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:THORN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:C
Other - Last Name:THORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NCC, LAC
Mailing Address - Street 1:4636 THELMA AVE
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-9579
Mailing Address - Country:US
Mailing Address - Phone:856-506-9084
Mailing Address - Fax:
Practice Address - Street 1:630 CLEMENTS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08007-1814
Practice Address - Country:US
Practice Address - Phone:856-547-1107
Practice Address - Fax:856-547-1130
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00470300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health