Healthcare Provider Details

I. General information

NPI: 1962440420
Provider Name (Legal Business Name): MARVIN BARRY CHARTOFF ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST
SPARTA NJ
07871-1916
US

IV. Provider business mailing address

11S SHORE TRL
SPARTA NJ
07871-1610
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-5535
  • Fax: 973-726-9706
Mailing address:
  • Phone: 862-432-2971
  • Fax: 973-726-9706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00104400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number35SI00104400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00104400
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number35SI00104400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: