| Potentiality Counseling & Psychotherapy | |
|
3804 Church Rd Mount Laurel NJ 08054-1106 | |
| (856) 745-6291 | |
| Not Available |
| Full Name | Potentiality Counseling & Psychotherapy |
|---|---|
| Speciality | Psychologist |
| Location | 3804 Church Rd, Mount Laurel, New Jersey |
| Authorized Official Name and Position | Stefan Carl Dombrowski (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8567456291 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Potentiality Counseling & Psychotherapy 6 Roberts Dr Cherry Hill NJ 08003-1016 Ph: (856) 745-6291 | Potentiality Counseling & Psychotherapy 3804 Church Rd Mount Laurel NJ 08054-1106 Ph: (856) 745-6291 |
| NPI Number | 1790282192 |
|---|---|
| Provider Enumeration Date | 04/11/2018 |
| Last Update Date | 09/14/2021 |
| Certification Date | 09/14/2021 |
| Medicare PECOS PAC ID | 3779967070 |
|---|---|
| Medicare Enrollment ID | O20220906002587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790282192 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 103TC2200X | Psychologist - Clinical Child & Adolescent | 35SI00420600 (New Jersey) | Secondary |
| Provider Name | Stefan Carl Dombrowski |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1962909226 PECOS PAC ID: 5597149898 Enrollment ID: I20220906002639 |
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