Organization
CENTRA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHLEEN MAGUIRE (DIRECTOR OF OPERATIONS)
(856) 985-3030
Entity
Organization
Contact information
Practice address
5000 SAGEMORE DR, SUITE 205, MARLTON, NJ 08053-4307
(856) 985-3030
(856) 985-8148
Mailing address
5000 SAGEMORE DR, SUITE 205, MARLTON, NJ 08053-4307
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CE883152
NJ
101YM0800X
Mental Health Counselor
CE883152
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE883152
GROUP NUMBER
NJ
Enumeration date
05/08/2007
Last updated
08/22/2020
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