Provider Demographics
NPI:1497186126
Name:PSYCHODRAMA NEW JERSEY LLC
Entity Type:Organization
Organization Name:PSYCHODRAMA NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:URMEY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, CP
Authorized Official - Phone:732-221-7306
Mailing Address - Street 1:PO BOX 3063
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-3063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1806 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2700
Practice Address - Country:US
Practice Address - Phone:732-221-7306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05441500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty