Provider Demographics
NPI:1790828572
Name:PREZIOSO, MICHAEL S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:PREZIOSO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 ANTHONY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN GARDNER
Mailing Address - State:NJ
Mailing Address - Zip Code:08826-3001
Mailing Address - Country:US
Mailing Address - Phone:908-832-7970
Mailing Address - Fax:
Practice Address - Street 1:186 CENTER ST
Practice Address - Street 2:SUITE 295
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1385
Practice Address - Country:US
Practice Address - Phone:908-735-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100359400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist