Provider Demographics
NPI:1568594026
Name:ADVANCE THRU PSYCHOTHERAPY & FAMILY DEVELOPMENT, PA
Entity Type:Organization
Organization Name:ADVANCE THRU PSYCHOTHERAPY & FAMILY DEVELOPMENT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFAIR-FISCH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:609-883-2577
Mailing Address - Street 1:2737 PRINCETON PIKE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3220
Mailing Address - Country:US
Mailing Address - Phone:609-883-2577
Mailing Address - Fax:609-883-2092
Practice Address - Street 1:2737 PRINCETON PIKE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3220
Practice Address - Country:US
Practice Address - Phone:609-883-2577
Practice Address - Fax:609-883-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100165100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ16146OtherCIGNA
NJP402017OtherOXFORD
NJ051524OtherVALUE OPTIONS
NJ41024000OtherMAGELLAN
NJAETNAOther3497258
NJV5704OtherEMPIRE BLUE CROSS SHIELD
NH0504980000OtherAMERIHEALTH INDEPENDENCE
NJAETNAOther3497258
NJP402017OtherOXFORD