Provider Demographics
NPI:1356923254
Name:PSYLENT VICTORY LLC
Entity type:Organization
Organization Name:PSYLENT VICTORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CILENTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-687-6240
Mailing Address - Street 1:301 ROUTE 9 N
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8562
Mailing Address - Country:US
Mailing Address - Phone:732-687-6240
Mailing Address - Fax:
Practice Address - Street 1:301 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8562
Practice Address - Country:US
Practice Address - Phone:732-687-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty