Provider Demographics
NPI:1104125129
Name:JOHN F. MCINERNEY PH.D. ,LLC
Entity type:Organization
Organization Name:JOHN F. MCINERNEY PH.D. ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MC INERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:609-463-1662
Mailing Address - Street 1:211 S MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2264
Mailing Address - Country:US
Mailing Address - Phone:609-463-1662
Mailing Address - Fax:609-463-1658
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2264
Practice Address - Country:US
Practice Address - Phone:609-463-1662
Practice Address - Fax:609-463-1658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01232103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092944Medicare PIN