MEDICARE: ACADEMY OF CLINICAL AND APPLIED PSYCHOANALYSIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1255845426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY OF CLINICAL AND APPLIED PSYCHOANALYSIS

Provider Business Mailing Address
First Line	:	301 S LIVINGSTON AVE
Second Line	:	SUITE 202
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039
Country	:	US
Telephone Number	:	973-629-1001
Fax Number	:	973-629-1003

Provider Business Practice Location Address
First Line	:	301 S LIVINGSTON AVE STE 202
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3929
Country	:	US
Telephone Number	:	973-629-1001
Fax Number	:	973-629-1003

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. VICKI SEMEL
Credential	:	PSYA
Telephone Number	:	973-629-1006

Provider Enumeration Date	:	11/27/2017
Last Update Date	:	11/27/2017

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