Healthcare Provider Details

I. General information

NPI: 1609268168
Provider Name (Legal Business Name): JACQUELINE MARIE WYKA MAHAJAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE M. WYKA PSYD

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1078
US

IV. Provider business mailing address

654 SPRINGFIELD AVE
BERKELEY HEIGHTS NJ
07922-1078
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number35SI00542100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00542100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: