Individual provider Active NPI

Victoria Demosthene, RN, MSN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Marlton, NJ
National Provider Identifier
1154652352
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
26NJ00275500 Issued in NJ
Practice address
765 E Route 70
Suite a-100
Marlton, NJ 08053-2341
Phone
(856) 797-4721
Fax
(856) 797-4785
NPI assigned
Jan 27, 2010
Last updated
Jan 27, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 26NJ00275500 NJ Primary

Addresses

Primary practice location

765 E Route 70
Suite a-100
Marlton, NJ 08053-2341

Mailing address

765 E Route 70
Suite a-100
Marlton, NJ 08053-2341
Phone (856) 797-4721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100427000289 NJ Practitioner - Nurse Practitioner 7911034749 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Family Guidance PCGroup PAC ID 2860396454, 164 clinicians

Practice addresses (Care Compare)

765 Route 70 E
BLDG a
Marlton, NJ 08053-2341
Phone (856) 983-3900

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
26NJ00275500NJMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Inpathy Behavioral Healthcare Group LLC Past Accepting new patients
Center for Family Guidance PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: victoria.demosthene.p1@direct.cfg.nextgenshare.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264550400000",
    "number": "1154652352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 E ROUTE 70",
            "address_2": "SUITE A-100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532341",
            "telephone_number": "856-797-4721",
            "fax_number": "856-797-4785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 E ROUTE 70",
            "address_2": "SUITE A-100",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080532341",
            "telephone_number": "856-797-4721",
            "fax_number": "856-797-4785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMOSTHENE",
        "first_name": "VICTORIA",
        "credential": "RN, MSN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-27",
        "last_updated": "2010-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00275500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

Verify at the official NPI Registry.