| Genuine Me Of South Jersey Inc | |
|
111 Church Rd Marlton NJ 08053 | |
| (609) 828-0097 | |
| (856) 802-0885 |
| Full Name | Genuine Me Of South Jersey Inc |
|---|---|
| Speciality | Social Worker |
| Location | 111 Church Rd, Marlton, New Jersey |
| Authorized Official Name and Position | Joanne R Fadool (PRESIDENT) |
| Authorized Official Contact | 6098280097 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genuine Me Of South Jersey Inc 3 Cranbury Hill Ct Mount Laurel NJ 08054-4849 Ph: (609) 828-0097 | Genuine Me Of South Jersey Inc 111 Church Rd Marlton NJ 08053 Ph: (609) 828-0097 |
| NPI Number | 1912316639 |
|---|---|
| Provider Enumeration Date | 08/06/2014 |
| Last Update Date | 08/16/2016 |
| Medicare PECOS PAC ID | 5698063337 |
|---|---|
| Medicare Enrollment ID | O20161012000385 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912316639 | NPI | - | NPPES |
| 0450088977 | Other | NJ | NEW JERSERY CERTIFICATE OF INC (PROFIT) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05576600 (New Jersey) | Primary |
| Provider Name | Joanne R Fadool |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558787564 PECOS PAC ID: 2860710902 Enrollment ID: I20150421001861 |
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