Provider Demographics
NPI:1730301425
Name:MCLOUGHLIN, MICHAEL BRENDAN (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRENDAN
Last Name:MCLOUGHLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:M
Other - Middle Name:BRENDAN
Other - Last Name:MCLOUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:25 ORCHARD STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834
Mailing Address - Country:US
Mailing Address - Phone:973-627-5553
Mailing Address - Fax:973-627-6757
Practice Address - Street 1:25 ORCHARD STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:973-627-5553
Practice Address - Fax:973-627-6757
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00370100103T00000X
NJ37FI00119100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist