Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 37LC00328700 | NJ |
NPI | 1528721651 |
---|---|
Provider Name | Ms. Jeri Fatia Mentor |
First Address | Trenton, NJ 08618-3968 |
Second Address | Trenton, NJ 08618-3968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2021 |
Last Update Date | 15/10/2021 |