Healthcare Provider Details

I. General information

NPI: 1255845426
Provider Name (Legal Business Name): ACADEMY OF CLINICAL AND APPLIED PSYCHOANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S LIVINGSTON AVE STE 202
LIVINGSTON NJ
07039-3929
US

IV. Provider business mailing address

301 S LIVINGSTON AVE SUITE 202
LIVINGSTON NJ
07039
US

V. Phone/Fax

Practice location:
  • Phone: 973-629-1001
  • Fax: 973-629-1003
Mailing address:
  • Phone: 973-629-1001
  • Fax: 973-629-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name: DR. VICKI SEMEL
Title or Position: EXECUTIVE DIRECTOR
Credential: PSYA
Phone: 973-629-1006