Provider Demographics
NPI:1942701198
Name:GARDEN STATE PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GARDEN STATE PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, ACS
Authorized Official - Phone:732-965-7255
Mailing Address - Street 1:49 BRANT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1550
Mailing Address - Country:US
Mailing Address - Phone:908-358-6176
Mailing Address - Fax:
Practice Address - Street 1:49 BRANT AVE STE 3
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1550
Practice Address - Country:US
Practice Address - Phone:908-358-6176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty