Provider Demographics
NPI:1528379880
Name:ACADEMY OF CLINICAL AND APPLIED PSYCHOANALYSIS
Entity Type:Organization
Organization Name:ACADEMY OF CLINICAL AND APPLIED PSYCHOANALYSIS
Other - Org Name:NORTH JERSEY CONSULTATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MIELE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-629-1001
Mailing Address - Street 1:301 S LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3932
Mailing Address - Country:US
Mailing Address - Phone:973-629-1001
Mailing Address - Fax:973-629-1003
Practice Address - Street 1:301 S LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3932
Practice Address - Country:US
Practice Address - Phone:973-629-1001
Practice Address - Fax:973-629-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100441900103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty