Provider Demographics
NPI:1720412885
Name:CHILD AND ADOLESCENT PSYCHIATRY OF SOUTHERN NEW JERSEY
Entity Type:Organization
Organization Name:CHILD AND ADOLESCENT PSYCHIATRY OF SOUTHERN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV, MSN, APN-BC
Authorized Official - Phone:215-806-5333
Mailing Address - Street 1:1525 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3129
Mailing Address - Country:US
Mailing Address - Phone:215-806-5333
Mailing Address - Fax:
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:SUITE Q-12
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:215-806-5333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00123800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1710041496OtherNPI