Healthcare Provider Details

I. General information

NPI: 1891463477
Provider Name (Legal Business Name): ANIELLA LINCOLN PEROLD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 BELLEVUE AVE STE 202
MONTCLAIR NJ
07043-1898
US

IV. Provider business mailing address

211 BELLEVUE AVE STE 202
MONTCLAIR NJ
07043-1898
US

V. Phone/Fax

Practice location:
  • Phone: 646-484-9557
  • Fax:
Mailing address:
  • Phone: 646-484-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00776900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: