Provider Demographics
NPI:1447739842
Name:LETITIA PICKEL, LLC
Entity Type:Organization
Organization Name:LETITIA PICKEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-991-1222
Mailing Address - Street 1:151 TOPSAIL LN
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2048
Mailing Address - Country:US
Mailing Address - Phone:609-661-3901
Mailing Address - Fax:
Practice Address - Street 1:1314 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2586
Practice Address - Country:US
Practice Address - Phone:609-991-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100584800251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1811232945OtherTYPE 1 NPI