Provider Demographics
NPI:1760912661
Name:RED OAK PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:RED OAK PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTELLINI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LCADC
Authorized Official - Phone:609-504-2522
Mailing Address - Street 1:376 FORK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4527
Mailing Address - Country:US
Mailing Address - Phone:609-504-2522
Mailing Address - Fax:
Practice Address - Street 1:100 HADDONTOWNE CT
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3602
Practice Address - Country:US
Practice Address - Phone:609-504-2522
Practice Address - Fax:856-427-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054281001041C0700X
PACW0163871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12223061OtherCAQH
1982930962OtherINDIVIDUAL NPI
NJ37LC00184100OtherSTATE OF NEW JERSEY
9823682OtherAETNA
NJ44SC05428100OtherSTATE OF NEW JERSEY
PACW016387OtherCOMMONWEALTH OF PENNSYLVANIA
PA2602881OtherHIGHMARK