Healthcare Provider Details

I. General information

NPI: 1346417557
Provider Name (Legal Business Name): KENDRA J HALUSKA PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE, MOB 2ND FLOOR ST. PETERS UNIVERSITY HOSPITAL
NEW BRUNSWICK NJ
08907
US

IV. Provider business mailing address

254 EASTON AVE, MOB 2ND FLOOR ST. PETERS UNIVERSITY HOSPITAL
NEW BRUNSWICK NJ
08907
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-8600
  • Fax: 732-937-9428
Mailing address:
  • Phone: 732-745-8600
  • Fax: 732-937-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017494-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number355100490300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number017494
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: