Provider Demographics
NPI:1255498382
Name:OVERLAND, MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:OVERLAND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 W MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1710
Mailing Address - Country:US
Mailing Address - Phone:973-994-1101
Mailing Address - Fax:973-994-1101
Practice Address - Street 1:513 W MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-1710
Practice Address - Country:US
Practice Address - Phone:973-994-1101
Practice Address - Fax:973-994-1101
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2016-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053710OtherVALUE OPTIONS
NJP1219024OtherOXFORD
NJ460217000OtherMAGELLAN
NJ460217000OtherMAGELLAN