Provider Demographics
NPI:1154703619
Name:PEARLSON, JONATHAN DANIEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DANIEL
Last Name:PEARLSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1023
Mailing Address - Country:US
Mailing Address - Phone:973-676-1000
Mailing Address - Fax:
Practice Address - Street 1:55 N GILBERT ST
Practice Address - Street 2:BUILDING 4, SUITE 4101
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4955
Practice Address - Country:US
Practice Address - Phone:732-842-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9298103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist