Provider Demographics
NPI:1417151689
Name:CROSSROADS PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:CROSSROADS PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-542-8043
Mailing Address - Street 1:CROSSROADS PSYCHOLOGICAL ASSOCIATES
Mailing Address - Street 2:170 AVE. AT THE COMMON, SUITE 8A
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4595
Mailing Address - Country:US
Mailing Address - Phone:732-542-8043
Mailing Address - Fax:
Practice Address - Street 1:CROSSROADS PSYCHOLOGICAL ASSOCIATES
Practice Address - Street 2:170 AVE. AT THE COMMON, SUITE 8A
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4595
Practice Address - Country:US
Practice Address - Phone:732-542-8043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ#1691103TC0700X
NJ#2539103TC0700X
NJ#3403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ060088Medicare UPIN