Provider Demographics
NPI:1992807887
Name:ON-SITE PSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:ON-SITE PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRENETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-438-7565
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877
Mailing Address - Country:US
Mailing Address - Phone:203-438-7565
Mailing Address - Fax:
Practice Address - Street 1:415 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4500
Practice Address - Country:US
Practice Address - Phone:203-438-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03333406Medicaid
V0W333Medicare ID - Type Unspecified
02846AMedicare ID - Type Unspecified
NY01540587Medicaid
V2W991Medicare ID - Type Unspecified
02846CMedicare ID - Type Unspecified
02846BMedicare ID - Type Unspecified