Provider Demographics
NPI:1013246966
Name:REGROUP WITH PRINCETTA'S BEHAVIORAL HEALTH SERVICES,LLC
Entity Type:Organization
Organization Name:REGROUP WITH PRINCETTA'S BEHAVIORAL HEALTH SERVICES,LLC
Other - Org Name:REGROUP PRINCETTA'S BEHVAIORAL HEALTH SERVICES,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST/PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PRINCETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-755-3392
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-0512
Mailing Address - Country:US
Mailing Address - Phone:908-755-3392
Mailing Address - Fax:
Practice Address - Street 1:PARK AVE STE 7
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060
Practice Address - Country:US
Practice Address - Phone:908-755-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty