Provider Demographics
NPI:1215354758
Name:PRINCETON CENTER FOR THERAPY AND ASSESSMENT, LLC
Entity type:Organization
Organization Name:PRINCETON CENTER FOR THERAPY AND ASSESSMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-924-5500
Mailing Address - Street 1:92 NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542-4530
Mailing Address - Country:US
Mailing Address - Phone:609-924-5500
Mailing Address - Fax:
Practice Address - Street 1:92 NASSAU ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4530
Practice Address - Country:US
Practice Address - Phone:609-924-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-22
Last Update Date:2014-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3995103G00000X, 103T00000X
NJ3997103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty