Provider Demographics
NPI:1396267217
Name:GOEPFERT, MARY JOAN (LSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:GOEPFERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 QUAKERBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-5243
Mailing Address - Country:US
Mailing Address - Phone:609-651-4001
Mailing Address - Fax:609-269-5761
Practice Address - Street 1:4065 QUAKERBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550
Practice Address - Country:US
Practice Address - Phone:609-651-4001
Practice Address - Fax:609-269-5761
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05989000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker