Provider Demographics
NPI:1306236179
Name:GENESIS P.A.C.E.S. LLP
Entity type:Organization
Organization Name:GENESIS P.A.C.E.S. LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEDICIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVIL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-393-1166
Mailing Address - Street 1:826 W STATE ST
Mailing Address - Street 2:SUITE A.
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-5350
Mailing Address - Country:US
Mailing Address - Phone:609-393-1166
Mailing Address - Fax:609-393-2140
Practice Address - Street 1:826 W STATE ST
Practice Address - Street 2:SUITE A.
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-5350
Practice Address - Country:US
Practice Address - Phone:609-393-1166
Practice Address - Fax:609-393-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 103G00000X, 103T00000X, 103TB0200X, 103TF0000X, 103TF0200X, 103TM1800X, 103TP2701X, 103TS0200X, 106H00000X, 103TC2200X
NJ103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty