Healthcare Provider Details

I. General information

NPI: 1134386550
Provider Name (Legal Business Name): VERED MIRIAM FRUMER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401A S VAN BRUNT ST SUITE 204
ENGLEWOOD NJ
07631-4600
US

IV. Provider business mailing address

401A S VAN BRUNT ST SUITE 204
ENGLEWOOD NJ
07631-4600
US

V. Phone/Fax

Practice location:
  • Phone: 201-894-9011
  • Fax: 201-894-9022
Mailing address:
  • Phone: 201-894-9011
  • Fax: 201-894-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4223
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4223
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4223
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4223
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: