Provider Demographics
NPI:1578256665
Name:JV SERENITY IOP PRINCETON LLC
Entity Type:Organization
Organization Name:JV SERENITY IOP PRINCETON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, LPC
Authorized Official - Phone:855-219-1877
Mailing Address - Street 1:PO BOX 31298
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33631-3298
Mailing Address - Country:US
Mailing Address - Phone:855-219-1877
Mailing Address - Fax:954-337-6238
Practice Address - Street 1:4065 QUAKERBRIDGE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON JCT
Practice Address - State:NJ
Practice Address - Zip Code:08550-5243
Practice Address - Country:US
Practice Address - Phone:855-219-1877
Practice Address - Fax:954-337-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder