Healthcare Provider Details

I. General information

NPI: 1104111095
Provider Name (Legal Business Name): MULTICULTURAL COUNSELING AND TESTING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2011
Last Update Date: 06/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

893 WESTFIELD AVE
ELIZABETH NJ
07208-1258
US

IV. Provider business mailing address

893 WESTFIELD AVE
ELIZABETH NJ
07208-1258
US

V. Phone/Fax

Practice location:
  • Phone: 973-652-2753
  • Fax: 908-998-1605
Mailing address:
  • Phone: 973-652-2753
  • Fax: 908-998-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4566
License Number StateNJ

VIII. Authorized Official

Name: DR. GHISLENE MEANCE
Title or Position: OWNER
Credential: PSY.D
Phone: 973-652-2753