Provider Demographics
NPI:1760018931
Name:PSYCHTHERAPEUTICS BY THE C. LLC
Entity Type:Organization
Organization Name:PSYCHTHERAPEUTICS BY THE C. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIJIOKE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNT-BC
Authorized Official - Phone:973-856-0849
Mailing Address - Street 1:39 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2096
Mailing Address - Country:US
Mailing Address - Phone:973-856-0849
Mailing Address - Fax:
Practice Address - Street 1:185 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-3332
Practice Address - Country:US
Practice Address - Phone:973-856-0849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336415553OtherNURSE PRACTIONER