Provider Demographics
NPI:1912112434
Name:TAORMINA, AUDREY (LPC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:TAORMINA
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 1:32 N BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3093
Mailing Address - Country:US
Mailing Address - Phone:856-228-4442
Mailing Address - Fax:856-228-4442
Practice Address - Street 1:32 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3093
Practice Address - Country:US
Practice Address - Phone:856-228-4442
Practice Address - Fax:856-228-4442
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00331100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2822628000OtherAMERIHEALTH PPO