Provider Demographics
NPI:1386787612
Name:SELECT PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SELECT PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DECICCO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-327-7755
Mailing Address - Street 1:205 N FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-1630
Mailing Address - Country:US
Mailing Address - Phone:201-327-7755
Mailing Address - Fax:201-461-0089
Practice Address - Street 1:205 N FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-1630
Practice Address - Country:US
Practice Address - Phone:201-327-7755
Practice Address - Fax:201-461-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3233103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1396765178OtherPSYCHOLOGIST