Provider Demographics
NPI:1700810447
Name:POINSETT, MARY JANET (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANET
Last Name:POINSETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 STATE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1400
Mailing Address - Country:US
Mailing Address - Phone:609-203-0773
Mailing Address - Fax:609-688-0844
Practice Address - Street 1:812 STATE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1400
Practice Address - Country:US
Practice Address - Phone:609-203-0773
Practice Address - Fax:609-688-0844
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002899001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC00289900OtherNJ LCSW LICENSE
NJ026995Medicare UPIN