Healthcare Provider Details

I. General information

NPI: 1679871982
Provider Name (Legal Business Name): ACHIEVE PSYCHOTHERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SHEMEN CT
LAKEWOOD NJ
08701-3662
US

IV. Provider business mailing address

14 SHEMEN CT
LAKEWOOD NJ
08701-3662
US

V. Phone/Fax

Practice location:
  • Phone: 973-826-0060
  • Fax:
Mailing address:
  • Phone: 973-826-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number25MA02575900
License Number StateNJ

VIII. Authorized Official

Name: DR. JAMES R COWAN JR.
Title or Position: PRESIDENT
Credential:
Phone: 973-826-0060