Provider Demographics
NPI:1831894237
Name:STARDUST AND SEROTONIN
Entity type:Organization
Organization Name:STARDUST AND SEROTONIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:CABRAL
Authorized Official - Last Name:FRENI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-296-9141
Mailing Address - Street 1:1040 KINGS HWY N STE 650
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-1931
Mailing Address - Country:US
Mailing Address - Phone:856-296-9141
Mailing Address - Fax:
Practice Address - Street 1:1040 KINGS HWY N STE 650
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1931
Practice Address - Country:US
Practice Address - Phone:856-296-9141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health