Healthcare Provider Details

I. General information

NPI: 1023729530
Provider Name (Legal Business Name): MCCD NEW JERSEY PSYCHIATRY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 FRONTAGE RD FL 1
HAMPTON NJ
08827-4031
US

IV. Provider business mailing address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 833-351-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGIA GAVERAS
Title or Position: OWNER/CHIEF MEDICAL OFFICER
Credential: DO
Phone: 917-309-7915