Provider Demographics
NPI:1770018939
Name:CORNERSTONE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CORNERSTONE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST, REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CYDNEY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:TERRERI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-773-8435
Mailing Address - Street 1:1612 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-7019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1540 ROUTE 138
Practice Address - Street 2:BUILDING 2, SUITE 201
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3763
Practice Address - Country:US
Practice Address - Phone:732-778-5009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00497400261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1932531563OtherINDIVIDUAL PROVIDER (TYPE 1) NPI