MEDICARE: JOHN STEPHEN LOCONTE PHD LLC

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	103TC0700X	Clinical	35S100359800	NJ

General Provider Information

NPI Number	:	1467776492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN STEPHEN LOCONTE PHD LLC

Provider Business Mailing Address
First Line	:	697 VALLEY ST
Second Line	:	SUITE 2A
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2641
Country	:	US
Telephone Number	:	973-762-7162
Fax Number	:	973-762-7164

Provider Business Practice Location Address
First Line	:	697 VALLEY ST
Second Line	:	SUITE 2A
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2641
Country	:	US
Telephone Number	:	973-762-7162
Fax Number	:	973-762-7164

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. JOHN S LOCONTE
Credential	:	PH.D.
Telephone Number	:	973-762-7162

Provider Enumeration Date	:	03/19/2010
Last Update Date	:	03/19/2010

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