Healthcare Provider Details

I. General information

NPI: 1922407816
Provider Name (Legal Business Name): PRINCETON PSYCHOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EWING ST SUITE C20-A
PRINCETON NJ
08540-2757
US

IV. Provider business mailing address

601 EWING ST SUITE C20-A
PRINCETON NJ
08540-2757
US

V. Phone/Fax

Practice location:
  • Phone: 609-250-2567
  • Fax:
Mailing address:
  • Phone: 609-250-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number35SI00531400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number35SI00531400
License Number StateNJ

VIII. Authorized Official

Name: DR. MONISHA MOTIWALA
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 609-250-2567