Provider Demographics
NPI:1598518466
Name:STORCK-MARTINEZ, CELENA (LSW)
Entity Type:Individual
Prefix:
First Name:CELENA
Middle Name:
Last Name:STORCK-MARTINEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3085
Mailing Address - Country:US
Mailing Address - Phone:609-907-0555
Mailing Address - Fax:
Practice Address - Street 1:76 W JIMMIE LEEDS RD STE 305
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9418
Practice Address - Country:US
Practice Address - Phone:609-916-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07024800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor