Provider Demographics
NPI:1346579109
Name:EXTENSIVE PSYCHOLOGICAL SERVICES,INC
Entity Type:Organization
Organization Name:EXTENSIVE PSYCHOLOGICAL SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MONACI
Authorized Official - Last Name:FAHAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-996-2863
Mailing Address - Street 1:20 GIBSON PL STE 206
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-4837
Mailing Address - Country:US
Mailing Address - Phone:732-483-4425
Mailing Address - Fax:732-483-4427
Practice Address - Street 1:20 GIBSON PL STE 206
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-4837
Practice Address - Country:US
Practice Address - Phone:732-483-4425
Practice Address - Fax:732-483-4427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00021400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty