Healthcare Provider Details

I. General information

NPI: 1467707067
Provider Name (Legal Business Name): CAROL CHU-PERALTA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL CHU PH.D

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SUMMIT AVE STE 205
MONTVALE NJ
07645-1763
US

IV. Provider business mailing address

160 SUMMIT AVE STE 205
MONTVALE NJ
07645-1763
US

V. Phone/Fax

Practice location:
  • Phone: 201-661-3375
  • Fax:
Mailing address:
  • Phone: 201-661-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number020708
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00569400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number020708
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: