Provider Demographics
NPI:1134659410
Name:DUCKETT & CHARLESTON PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DUCKETT & CHARLESTON PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-456-1584
Mailing Address - Street 1:1303 ROUTE 130 N
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2014
Mailing Address - Country:US
Mailing Address - Phone:609-456-1584
Mailing Address - Fax:
Practice Address - Street 1:1303 ROUTE 130 N
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-2014
Practice Address - Country:US
Practice Address - Phone:609-456-1584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5241261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1376967760Medicaid