Provider Demographics
NPI:1871642405
Name:VERNALEKEN, CLAIRE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:
Last Name:VERNALEKEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 RIFLE CAMP RD
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3132
Mailing Address - Country:US
Mailing Address - Phone:973-837-1158
Mailing Address - Fax:
Practice Address - Street 1:843 RIFLE CAMP RD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3132
Practice Address - Country:US
Practice Address - Phone:973-832-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8424403Medicaid
NJ8424403Medicaid