Provider Demographics
NPI:1255715553
Name:POOLE, DENISE R (LPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:POOLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 187
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021
Mailing Address - Country:US
Mailing Address - Phone:856-287-5240
Mailing Address - Fax:856-335-4829
Practice Address - Street 1:130 W. WHITEHORSE PK, IB HEART 2 HEART
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009
Practice Address - Country:US
Practice Address - Phone:856-352-5424
Practice Address - Fax:856-335-4829
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJLAC37AC00272100106H00000X
PAPC011697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health