Basic Information
| Provider Information | |||||||||
| NPI: | 1588953376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRICE | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ALI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 E ORMOND AVE | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080342053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564281300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 499 COOPER LANDING RD | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080022504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8564828747 | ||||||||
| FaxNumber: | 8564828340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.