Provider Demographics
NPI:1235230608
Name:DEMETRIADES, HELEN A (PSY D)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:A
Last Name:DEMETRIADES
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-5106
Mailing Address - Country:US
Mailing Address - Phone:732-701-8400
Mailing Address - Fax:732-701-8419
Practice Address - Street 1:1617 BEAVER DAM RD
Practice Address - Street 2:DBA BRIDGE MENTAL HEALTH
Practice Address - City:PT PLEASANT
Practice Address - State:NJ
Practice Address - Zip Code:08742-5106
Practice Address - Country:US
Practice Address - Phone:732-701-8400
Practice Address - Fax:732-701-8419
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05162600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
056110Medicare ID - Type Unspecified