Provider Demographics
NPI:1457949190
Name:MJC PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:MJC PSYCHOTHERAPY SERVICES
Other - Org Name:MJC PSYCHOTHERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-704-3164
Mailing Address - Street 1:622-624 VALLEY ROAD
Mailing Address - Street 2:SUITE 6C
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043
Mailing Address - Country:US
Mailing Address - Phone:201-704-3164
Mailing Address - Fax:877-615-7339
Practice Address - Street 1:622-624 VALLEY ROAD
Practice Address - Street 2:SUITE 6C
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043
Practice Address - Country:US
Practice Address - Phone:201-704-3164
Practice Address - Fax:877-615-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty