Healthcare Provider Details

I. General information

NPI: 1023990041
Provider Name (Legal Business Name): JERSEY PSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 ROUTE 17 STE 1- 1160
PARAMUS NJ
07652
US

IV. Provider business mailing address

501 ROUTE 17 STE 1- 1160
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 201-523-2129
  • Fax:
Mailing address:
  • Phone: 201-523-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DIANE SOSA
Title or Position: CLINICIAN
Credential:
Phone: 201-523-2129