Provider Demographics
NPI:1255488151
Name:HYMAN, ELAINE M (PSYD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:HYMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3747 CHURCH RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1144
Mailing Address - Country:US
Mailing Address - Phone:856-465-5189
Mailing Address - Fax:
Practice Address - Street 1:3747 CHURCH RD
Practice Address - Street 2:111
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1144
Practice Address - Country:US
Practice Address - Phone:856-465-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3981103TC0700X
PAPS008967L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ262645000OtherMIS#