Provider Demographics
NPI:1215186184
Name:CENTRAL JERSEY PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-845-5068
Mailing Address - Street 1:205 ROUTE 9 N
Mailing Address - Street 2:SUITE # 6
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8561
Mailing Address - Country:US
Mailing Address - Phone:732-845-5068
Mailing Address - Fax:
Practice Address - Street 1:205 ROUTE 9 N
Practice Address - Street 2:SUITE # 6
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8561
Practice Address - Country:US
Practice Address - Phone:732-845-5068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4513261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center