Provider Demographics
NPI:1699186569
Name:BADENOCH, MARY ANN (LPC)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:BADENOCH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HARVEY DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1217
Mailing Address - Country:US
Mailing Address - Phone:908-988-0930
Mailing Address - Fax:
Practice Address - Street 1:28 HARVEY DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1217
Practice Address - Country:US
Practice Address - Phone:908-988-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11774101YM0800X
NJ37PC00491100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health