Provider Demographics
NPI:1255592531
Name:PSYCHOLOGICAL GROWTH SERVICES, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL GROWTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-951-9479
Mailing Address - Street 1:36 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1331
Mailing Address - Country:US
Mailing Address - Phone:973-951-9479
Mailing Address - Fax:
Practice Address - Street 1:157 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1353
Practice Address - Country:US
Practice Address - Phone:973-951-9479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100432000103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty