Provider Demographics
NPI:1508432006
Name:PSYCHOLOGICAL SERVICES FOR THE INJURED, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES FOR THE INJURED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-207-5322
Mailing Address - Street 1:185 CENTRAL AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3318
Mailing Address - Country:US
Mailing Address - Phone:201-207-6294
Mailing Address - Fax:
Practice Address - Street 1:185 CENTRAL AVE STE 311
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3318
Practice Address - Country:US
Practice Address - Phone:201-207-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty