Healthcare Provider Details

I. General information

NPI: 1063914935
Provider Name (Legal Business Name): FAITH DUNKEL, PSY.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HILLSIDE AVE STE 108
MONTCLAIR NJ
07042-2129
US

IV. Provider business mailing address

8 HILLSIDE AVE STE 108
MONTCLAIR NJ
07042-2129
US

V. Phone/Fax

Practice location:
  • Phone: 973-826-0335
  • Fax:
Mailing address:
  • Phone: 973-826-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number35S100565800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number35S100565800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number35S100565800
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number35S100565800
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35S100565800
License Number StateNJ

VIII. Authorized Official

Name: DR. FAITH DUNKEL
Title or Position: OWNER
Credential: PSY.D.
Phone: 973-826-0335