Provider Demographics
NPI:1770658569
Name:UPPER MONTCLAIR PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:UPPER MONTCLAIR PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SREDNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-744-9130
Mailing Address - Street 1:543 VALLEY RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1881
Mailing Address - Country:US
Mailing Address - Phone:973-744-9130
Mailing Address - Fax:973-863-2354
Practice Address - Street 1:543 VALLEY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1881
Practice Address - Country:US
Practice Address - Phone:973-744-9130
Practice Address - Fax:973-863-2354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ03509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ108181Medicare UPIN