Provider Demographics
NPI:1841420841
Name:MARCIA LAKY PHD
Entity Type:Organization
Organization Name:MARCIA LAKY PHD
Other - Org Name:MARCIA LAKY PHD COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-633-1554
Mailing Address - Street 1:1330 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4057
Mailing Address - Country:US
Mailing Address - Phone:973-633-1554
Mailing Address - Fax:973-633-1564
Practice Address - Street 1:1330 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4057
Practice Address - Country:US
Practice Address - Phone:973-633-1554
Practice Address - Fax:973-633-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00276700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty