Provider Demographics
NPI:1003040312
Name:FAY, JAMES W IV (LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:FAY
Suffix:IV
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 CARLTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1213
Mailing Address - Country:US
Mailing Address - Phone:908-596-0095
Mailing Address - Fax:
Practice Address - Street 1:1065 RTE 22
Practice Address - Street 2:SUITE 3 D
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2949
Practice Address - Country:US
Practice Address - Phone:908-231-0511
Practice Address - Fax:908-231-1115
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ37PC00423800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health