Provider Demographics
NPI:1780975458
Name:PSYCH-ED SERVICES, INC
Entity type:Organization
Organization Name:PSYCH-ED SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-674-1392
Mailing Address - Street 1:781 COMMANCHE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2903
Mailing Address - Country:US
Mailing Address - Phone:201-847-1054
Mailing Address - Fax:201-847-9647
Practice Address - Street 1:781 COMMANCHE LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07417-2903
Practice Address - Country:US
Practice Address - Phone:201-847-1054
Practice Address - Fax:201-847-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05578500101YP2500X
NJ44SC045359001041C0700X
NJ44SC053575001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty