Provider Demographics
NPI:1396802682
Name:PSYCHOLOGICAL ASSOCIATES OF NORTH JERSEY LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF NORTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:ROSEN
Authorized Official - Last Name:FALLIG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-654-5093
Mailing Address - Street 1:254 MOUNTAIN AVE # B
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2407
Mailing Address - Country:US
Mailing Address - Phone:908-979-1144
Mailing Address - Fax:908-979-1068
Practice Address - Street 1:254 MOUNTAIN AVE # B
Practice Address - Street 2:SUITE 202
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2407
Practice Address - Country:US
Practice Address - Phone:908-979-1144
Practice Address - Fax:908-979-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFA 729187Medicare ID - Type Unspecified