Provider Demographics
NPI:1770654246
Name:PASTERNAK, MARCY ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:ANNE
Last Name:PASTERNAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-5418
Mailing Address - Country:US
Mailing Address - Phone:908-769-7949
Mailing Address - Fax:
Practice Address - Street 1:96 JOAN DR
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-5418
Practice Address - Country:US
Practice Address - Phone:908-769-7949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00201100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical