Provider Demographics
NPI:1508239484
Name:SPECIALIZED PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SPECIALIZED PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-564-6097
Mailing Address - Street 1:636 MORRIS TPKE
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2622
Mailing Address - Country:US
Mailing Address - Phone:973-564-6097
Mailing Address - Fax:
Practice Address - Street 1:636 MORRIS TPKE
Practice Address - Street 2:SUITE 2G
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2622
Practice Address - Country:US
Practice Address - Phone:973-564-6097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ153-081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty