Provider Demographics
NPI:1043320104
Name:CRAIG W. PEARL, PSY.D., P.C.
Entity Type:Organization
Organization Name:CRAIG W. PEARL, PSY.D., P.C.
Other - Org Name:PEARL PROF PSYCH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:WARHOL
Authorized Official - Last Name:SKUBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-778-2100
Mailing Address - Street 1:3804 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1106
Mailing Address - Country:US
Mailing Address - Phone:856-778-2100
Mailing Address - Fax:856-787-9588
Practice Address - Street 1:3804 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1106
Practice Address - Country:US
Practice Address - Phone:856-778-2100
Practice Address - Fax:856-787-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7406401Medicaid
NJ898160Medicare PIN