Provider Demographics
NPI:1710199559
Name:BORDENTOWN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:BORDENTOWN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-298-9144
Mailing Address - Street 1:410 FARNSWORTH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-2005
Mailing Address - Country:US
Mailing Address - Phone:609-298-9144
Mailing Address - Fax:609-298-9288
Practice Address - Street 1:410 FARNSWORTH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-2005
Practice Address - Country:US
Practice Address - Phone:609-298-9144
Practice Address - Fax:609-298-9288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051970001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty