Provider Demographics
NPI:1598209595
Name:LICHTMAN, JEREMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:LICHTMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TOWER CENTER BLVD
Mailing Address - Street 2:SUITE 1943
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-1100
Mailing Address - Country:US
Mailing Address - Phone:732-788-6009
Mailing Address - Fax:
Practice Address - Street 1:2 TOWER CENTER BLVD
Practice Address - Street 2:SUITE 1943
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1100
Practice Address - Country:US
Practice Address - Phone:732-788-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ989192103TS0200X
NJTP# 163-066101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool