Provider Demographics
NPI:1710139340
Name:MADREPERL, PJ (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PJ
Middle Name:
Last Name:MADREPERL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 BUCKINGHAM CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-4211
Mailing Address - Country:US
Mailing Address - Phone:732-513-7647
Mailing Address - Fax:732-671-4551
Practice Address - Street 1:1051 TUCKERTON RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2665
Practice Address - Country:US
Practice Address - Phone:732-513-7647
Practice Address - Fax:732-671-4551
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048696001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical