Provider Demographics
NPI:1184352759
Name:DREAM AND PLAY PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:DREAM AND PLAY PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:732-595-8587
Mailing Address - Street 1:PO BOX 644
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-0644
Mailing Address - Country:US
Mailing Address - Phone:732-595-8587
Mailing Address - Fax:
Practice Address - Street 1:152 OLDWICK RD
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-5015
Practice Address - Country:US
Practice Address - Phone:908-439-3456
Practice Address - Fax:908-439-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1407246937Other1L-9449