Provider Demographics
NPI:1831637917
Name:VAN REIPEN COUNSELING AND PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:VAN REIPEN COUNSELING AND PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-780-3512
Mailing Address - Street 1:70 VAN REIPEN AVE
Mailing Address - Street 2:GROUND FL
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2806
Mailing Address - Country:US
Mailing Address - Phone:201-780-3512
Mailing Address - Fax:
Practice Address - Street 1:70 VAN REIPEN AVE
Practice Address - Street 2:GROUND FL
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2806
Practice Address - Country:US
Practice Address - Phone:201-780-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100571300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty