Provider Demographics
NPI:1508228537
Name:PSYCHO-EDUCATIONAL ASSOCIATES
Entity Type:Organization
Organization Name:PSYCHO-EDUCATIONAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC, NJCSP
Authorized Official - Phone:973-460-5160
Mailing Address - Street 1:999 RIVERVIEW DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512
Mailing Address - Country:US
Mailing Address - Phone:973-406-5160
Mailing Address - Fax:973-406-5101
Practice Address - Street 1:999 RIVERVIEW DR.
Practice Address - Street 2:SUITE 201
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512
Practice Address - Country:US
Practice Address - Phone:973-460-5160
Practice Address - Fax:973-460-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00359500251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health