Healthcare Provider Details

I. General information

NPI: 1699634469
Provider Name (Legal Business Name): NORTHEAST PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CHURCH ST STE L4
MONTCLAIR NJ
07042-2745
US

IV. Provider business mailing address

52 FAIRVIEW AVE
WEST ORANGE NJ
07052-3141
US

V. Phone/Fax

Practice location:
  • Phone: 862-754-5441
  • Fax:
Mailing address:
  • Phone: 862-754-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DAWN MICHELLE MCDONALD
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 862-754-5441