Healthcare Provider Details

I. General information

NPI: 1548647720
Provider Name (Legal Business Name): ATLANTIC NEUROPSYCHOLOGY AND PSYCHOTHERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 CHURCH ST
MANASQUAN NJ
08736-1150
US

IV. Provider business mailing address

1330 LAUREL AVE
SEA GIRT NJ
08750-2300
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-7568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. EILEEN MCCARTHY SITTIG
Title or Position: OWNER
Credential: PH.D.
Phone: 908-309-7568