Individual
MRS. MARY LEE GANESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
218A SUNSET RD, SCREENING AND CRISIS INTERVENTION PROGRAM, WILLINGBORO, NJ 08046-1110
(609) 835-6180
(609) 835-7962
Mailing address
1289 ROUTE 38, HAINESPORT, NJ 08036-2730
(609) 267-5656
(609) 267-8892
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
172V00000X
172V00000X
NJ
Enumeration date
04/14/2009
Last updated
04/27/2009
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