Provider Demographics
NPI:1669769303
Name:SERRA ASSOCIATES LLC
Entity type:Organization
Organization Name:SERRA ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUCOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-880-7920
Mailing Address - Street 1:337 MARKET ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5313
Mailing Address - Country:US
Mailing Address - Phone:201-880-7920
Mailing Address - Fax:201-880-7921
Practice Address - Street 1:337 MARKET ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5313
Practice Address - Country:US
Practice Address - Phone:201-880-7920
Practice Address - Fax:201-880-7921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI01593103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ056650Medicare UPIN