Provider Demographics
NPI:1538644505
Name:DENARIO PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:DENARIO PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DENARIO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-381-5255
Mailing Address - Street 1:1060 KINGS HWY N STE 311
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1910
Mailing Address - Country:US
Mailing Address - Phone:717-381-5255
Mailing Address - Fax:856-779-2705
Practice Address - Street 1:1060 KINGS HWY N STE 311
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1910
Practice Address - Country:US
Practice Address - Phone:717-381-5255
Practice Address - Fax:856-779-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0601217Medicaid