Individual provider Active NPI

Joanna Petrides, PSY.D.

  • Psychologist
  • Mullica Hill, NJ
National Provider Identifier
1821496936
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
35SI00553000 Issued in NJ
Practice address
700 Mullica Hill Rd
Mullica Hill, NJ 08062-4413
Phone
(856) 508-1000
NPI assigned
Dec 5, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PS017752 PA
Psychologist 103T00000X 35SI00553000 NJ Primary
Clinical Psychologist 103TC0700X 35SI00553000 NJ
Clinical Psychologist 103TC0700X PS017752 PA

Addresses

Primary practice location

700 Mullica Hill Rd
Mullica Hill, NJ 08062-4413

Mailing address

700 Mullica Hill Rd
Mullica Hill, NJ 08062-4413

Other identifiers 1

IdentifierTypeStateIssuer
0499056MedicaidNJ

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jpetrides136200@directvirtua.org
Direct Messaging Address jpetrides136200@directvirtua.org

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160309000280 NJ Practitioner - Clinical Psychologist 7911203567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
81.15 of 100Reported as group
Quality
62.28
Promoting interoperability
100
Improvement activities
40
Cost
74.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35SI00553000NJMDPsychologist
PS017752PAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Virtua Medical Group, PA CurrentSince Jun 5, 2023 Accepting new patients
Virtua Medical Group, PA CurrentSince Jun 1, 2024 Accepting new patients
Virtua Medical Group, PA CurrentSince Jun 5, 2023 Accepting new patients
Rowansom Dept of Obstetrics Gynecology Past Accepting new patients

Locations

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

405 Hurffville Crosskeys Rd
Ste 101
Sewell, NJ 08080
Phone (856) 218-0300

42 E Laurel Rd
Ste 1700
Stratford, NJ 08084
Phone (856) 482-9000

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1417737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1821496936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 MULLICA HILL RD",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080624413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 MULLICA HILL RD",
            "city": "MULLICA HILL",
            "state": "NJ",
            "postal_code": "080624413",
            "telephone_number": "856-508-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIDES",
        "first_name": "JOANNA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-05",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS017752",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35SI00553000",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00553000",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS017752",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0499056",
            "state": "NJ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpetrides136200@directvirtua.org",
            "affiliation": "N",
            "address_1": "42 E Laurel Rd Ste 2100-A1",
            "city": "Stratford",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080841354",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpetrides136200@directvirtua.org",
            "affiliation": "N",
            "address_1": "405 Hurffville Crosskeys Rd Ste 101",
            "city": "Sewell",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080809340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mullica Hill, NJ

Sources for this page

Verify at the official NPI Registry.