NPIMap

Organization Active NPI

Fresh Start Family Therapy Services

  • Marriage & Family Therapist
  • Voorhees, NJ
National Provider Identifier
1265059067
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
FRESH START FAMILY THERAPY SERVICES
Practice address
600 Somerdale Rd Ste 101
Voorhees, NJ 08043-1858
Phone
(856) 220-7035
Fax
(856) 595-9377
NPI assigned
Jun 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Authorized official

Name
Ms. Bridget Juanique Lark, LMFTNPI 1386125946
Title
Owner
Phone
(856) 220-7035

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

600 Somerdale Rd Ste 101
Voorhees, NJ 08043-1858

Mailing address

38 Walnut Ave
Lindenwold, NJ 08021-1635
Phone (856) 220-7035

Other identifiers 1

IdentifierTypeStateIssuer
1386125946MedicaidNJ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address bridget@freshstartfamilytherapyservices.com Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1593388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593388800000",
    "number": "1265059067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 WALNUT AVE",
            "city": "LINDENWOLD",
            "state": "NJ",
            "postal_code": "080211635",
            "telephone_number": "856-220-7035",
            "fax_number": "856-595-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 SOMERDALE RD STE 101",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080431858",
            "telephone_number": "856-220-7035",
            "fax_number": "856-595-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START FAMILY THERAPY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-29",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A",
        "authorized_official_last_name": "LARK",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "JUANIQUE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "856-220-7035",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386125946",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bridget@freshstartfamilytherapyservices.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "600 Somerdale Rd Ste 101",
            "city": "Voorhees",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080431858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Voorhees, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.