Provider Demographics
NPI:1376093161
Name:ELIZABETH A. CIERI, PSY.D. CO
Entity Type:Organization
Organization Name:ELIZABETH A. CIERI, PSY.D. CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CIERI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-509-0090
Mailing Address - Street 1:209 COOPER AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1883
Mailing Address - Country:US
Mailing Address - Phone:973-509-0090
Mailing Address - Fax:973-744-4993
Practice Address - Street 1:209 COOPER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1883
Practice Address - Country:US
Practice Address - Phone:973-509-0090
Practice Address - Fax:973-744-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1429OtherMEDICARE PTAN
1420OtherMEDICARE PTAN