Provider Demographics
NPI:1134776461
Name:CENTER FOR FORENSIC AND CLINICAL PSYCHOLOGY OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:CENTER FOR FORENSIC AND CLINICAL PSYCHOLOGY OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:215-917-1469
Mailing Address - Street 1:64 MACCULLOCH AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5480
Mailing Address - Country:US
Mailing Address - Phone:973-267-7767
Mailing Address - Fax:833-446-0150
Practice Address - Street 1:64 MACCULLOCH AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5480
Practice Address - Country:US
Practice Address - Phone:973-267-7767
Practice Address - Fax:833-446-0150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty