Provider Demographics
NPI:1053635409
Name:DELL, MARK R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:DELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Mailing Address - Street 2:SUITE-5
Mailing Address - City:HAMILTON SQ
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3536
Mailing Address - Country:US
Mailing Address - Phone:609-586-1586
Mailing Address - Fax:
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD
Practice Address - Street 2:SUITE-5
Practice Address - City:HAMILTON SQ
Practice Address - State:NJ
Practice Address - Zip Code:08690-3536
Practice Address - Country:US
Practice Address - Phone:609-586-1586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00480700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist