Provider Demographics
NPI:1134185200
Name:PERE, GENEVIEVE (PHD)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:PERE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GORDON WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3957
Mailing Address - Country:US
Mailing Address - Phone:609-924-7667
Mailing Address - Fax:
Practice Address - Street 1:20 GORDON WAY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3957
Practice Address - Country:US
Practice Address - Phone:609-924-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ03059103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6289002Medicaid
NJ6289002Medicaid