Healthcare Provider Details

I. General information

NPI: 1114237484
Provider Name (Legal Business Name): ERIKA JANUARY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BEAUVOIR AVE. OVERLOOK HOSPITAL
SUMMIT NJ
07901
US

IV. Provider business mailing address

99 BEAUVOIR AVE.
SUMMIT NJ
07901
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5794
  • Fax:
Mailing address:
  • Phone: 908-522-5794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4682
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: