Provider Demographics
NPI:1972648053
Name:NORTH RIVER PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTH RIVER PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARJALA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-754-0751
Mailing Address - Street 1:11205 ALPHARETTA HWY.
Mailing Address - Street 2:STE. A-4
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-754-0751
Mailing Address - Fax:770-754-0752
Practice Address - Street 1:11205 ALPHARETTA HWY.
Practice Address - Street 2:STE. A-4
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-754-0751
Practice Address - Fax:770-754-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001128103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBCLTMedicare ID - Type Unspecified