Provider Demographics
NPI:1508503038
Name:MID-ATLANTIC PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:MID-ATLANTIC PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-433-5868
Mailing Address - Street 1:1062 LIVINGSTON AVE UNIT 7071
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-8003
Mailing Address - Country:US
Mailing Address - Phone:973-433-5868
Mailing Address - Fax:
Practice Address - Street 1:75 RARITAN AVE STE 225
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2442
Practice Address - Country:US
Practice Address - Phone:973-433-5868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health