Provider Demographics
NPI:1619187556
Name:CENTER FOR PSYCHOLOGY AND COUNSELING
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOLOGY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-821-6810
Mailing Address - Street 1:PO BOX 1458
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1458
Mailing Address - Country:US
Mailing Address - Phone:732-821-6810
Mailing Address - Fax:
Practice Address - Street 1:3186 STATE ROUTE 27
Practice Address - Street 2:SUITE 101
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1513
Practice Address - Country:US
Practice Address - Phone:732-821-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00131100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLA637286Medicare ID - Type Unspecified