1104132026 NPI number — RECOVERY AND DISCOVERY PSYCH ASSOCIATES LLC

Table of content: (NPI 1104132026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104132026 NPI number — RECOVERY AND DISCOVERY PSYCH ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY AND DISCOVERY PSYCH ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104132026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 DAVIDSON AVE, SUITE 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-213-1311
Provider Business Mailing Address Fax Number:
732-613-9192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 DAVIDSON AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-213-1311
Provider Business Practice Location Address Fax Number:
732-613-9192
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ETTS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
732-213-1311

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  37LC00101000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 44SC05321300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com