Provider Demographics
NPI:1194108498
Name:DATCHI, CORINNE CECILE (PHD, ABPP)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:CECILE
Last Name:DATCHI
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 PLEASANT VALLEY WAY
Mailing Address - Street 2:UNIT 15
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1300
Mailing Address - Country:US
Mailing Address - Phone:812-360-5143
Mailing Address - Fax:
Practice Address - Street 1:35 DEFOREST AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2155
Practice Address - Country:US
Practice Address - Phone:812-360-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00535000103T00000X
ABPP # 7521103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily