MEDICARE: CHRISTIAN PSYCHOLOGICAL STUDIES INSTITUTE, 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	102L00000X	Psychoanalyst

General Provider Information

NPI Number	:	1578834594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN PSYCHOLOGICAL STUDIES INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	621 WESTWOOD AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5008
Country	:	US
Telephone Number	:	732-822-7279
Fax Number	:

Provider Business Practice Location Address
First Line	:	1985 ROUTE 34
Second Line	:	SUITE A9
City	:	WALL TOWNSHIP
State	:	NJ
Zip	:	07719-9100
Country	:	US
Telephone Number	:	732-822-7279
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. EVA KLOSTREICH
Credential	:	PHD
Telephone Number	:	732-822-7279

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	01/23/2012

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