Provider Demographics
NPI:1417362468
Name:TATEWIDE CLINICAL SERVICES, LLC
Entity Type:Organization
Organization Name:TATEWIDE CLINICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST9
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERREIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:908-391-7315
Mailing Address - Street 1:PO BOX 5247
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-0247
Mailing Address - Country:US
Mailing Address - Phone:908-391-7315
Mailing Address - Fax:
Practice Address - Street 1:345 SOMERSET ST
Practice Address - Street 2:SUITE L5
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4774
Practice Address - Country:US
Practice Address - Phone:908-391-7315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00294300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty