Provider Demographics
NPI:1538221650
Name:CHILD & ADOLESCENT PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:CHILD & ADOLESCENT PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RHONA
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-427-0757
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-0001
Mailing Address - Country:US
Mailing Address - Phone:856-321-1123
Mailing Address - Fax:856-427-0757
Practice Address - Street 1:900 KINGS HWY N
Practice Address - Street 2:SUITE 201
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1516
Practice Address - Country:US
Practice Address - Phone:856-321-1123
Practice Address - Fax:856-427-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03913251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSI03913OtherPSYCHOLOGY LICENSE