| Organization Name: | BORDENTOWN COUNSELING CENTER, LLC |
| NPI Number: | 1710199559 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANA PETERSON (CLINICAL DIRECTOR) |
| Mailing Address: | 410 Farnsworth Ave Suite 1a Bordentown |
| State: | NJ US |
| Postal Code: | 085052005 |
| Phone Number: | 6092989144 |
| Fax Number: | 6092989288 |
| NPI Enumeration Date: | 05/04/2007 |
| NPI Last Update Date: | 03/26/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC05197000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |