Provider Demographics
NPI:1790199537
Name:MONA W. BIRK, PHD, LLC
Entity Type:Organization
Organization Name:MONA W. BIRK, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-307-3768
Mailing Address - Street 1:32 HOPKINSON CT
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2982
Mailing Address - Country:US
Mailing Address - Phone:908-306-0774
Mailing Address - Fax:908-306-0607
Practice Address - Street 1:32 HOPKINSON CT
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-2982
Practice Address - Country:US
Practice Address - Phone:908-306-0774
Practice Address - Fax:908-306-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC0700X
NJ26NC04510500364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty