Provider Demographics
NPI:1811060148
Name:CANTRELL, JEANNE DAWN (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:DAWN
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:918 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4308
Mailing Address - Country:US
Mailing Address - Phone:215-493-1862
Mailing Address - Fax:215-321-4265
Practice Address - Street 1:1000 HERRONTOWN RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7716
Practice Address - Country:US
Practice Address - Phone:609-560-9116
Practice Address - Fax:215-321-4265
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100293500103TC0700X
PAPS007211L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051527Medicare PIN