Healthcare Provider Details

I. General information

NPI: 1376247445
Provider Name (Legal Business Name): EDWARD M BARRETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 KAREN DR
MILLTOWN NJ
08850-2124
US

IV. Provider business mailing address

PO BOX 603
MILLTOWN NJ
08850-0603
US

V. Phone/Fax

Practice location:
  • Phone: 732-297-9696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD M BARRETT
Title or Position: OWNER
Credential: PHD
Phone: 732-297-9696