Provider Demographics
NPI:1275893547
Name:GEORGALLAS, JANICE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:GEORGALLAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2608
Mailing Address - Country:US
Mailing Address - Phone:201-336-2833
Mailing Address - Fax:
Practice Address - Street 1:139 ASHLEY PL
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2608
Practice Address - Country:US
Practice Address - Phone:201-336-2833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00133600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional