Provider Demographics
NPI:1356550560
Name:DAVID, ALTHEA D (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALTHEA
Middle Name:D
Last Name:DAVID
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ALTHEA
Other - Middle Name:D
Other - Last Name:LAZZARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1135 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3346
Mailing Address - Country:US
Mailing Address - Phone:888-244-5373
Mailing Address - Fax:
Practice Address - Street 1:1135 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3346
Practice Address - Country:US
Practice Address - Phone:888-244-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100442900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist