# GENESIS P.A.C.E.S. LLP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306236179
- **Authorized official:** DR. CLEDICIANNE DORVIL PSY.D (CO-OWNER)
- **Authorized official phone:** (609) 393-1166

## Contact information

- **Practice address:** 826 W STATE ST, SUITE A., TRENTON, NJ 08618-5350
- **Practice address phone:** (609) 393-1166
- **Practice address fax:** (609) 393-2140
- **Mailing address:** 826 W STATE ST, SUITE A., TRENTON, NJ 08618-5350
- **Mailing address phone:** (609) 393-1166
- **Mailing address fax:** (609) 393-2140

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | — |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103G00000X | Clinical Neuropsychologist | — | NULL | — |
| 103G00000X | Clinical Neuropsychologist | — | — | — |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | NULL | — |
| 103TB0200X | Cognitive & Behavioral Psychologist | — | — | — |
| 103TC1900X | Counseling Psychologist | — | NJ | — |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |
| 103TF0000X | Family Psychologist | — | NULL | — |
| 103TF0000X | Family Psychologist | — | — | — |
| 103TF0200X | Forensic Psychologist | — | NULL | — |
| 103TF0200X | Forensic Psychologist | — | — | — |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | — | NULL | — |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | — | — | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | NULL | — |
| 103TP2701X | Group Psychotherapy Psychologist | — | — | — |
| 103TS0200X | School Psychologist | — | NULL | — |
| 103TS0200X | School Psychologist | — | — | — |
| 106H00000X | Marriage & Family Therapist | — | NULL | — |
| 106H00000X | Marriage & Family Therapist | — | — | — |

## Other

- **Enumeration date:** 01/30/2015
- **Last updated:** 05/06/2015