Healthcare Provider Details

I. General information

NPI: 1366599573
Provider Name (Legal Business Name): STAFFIN & TALCOFF ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 JOHNSON AVE
TEANECK NJ
07666-3151
US

IV. Provider business mailing address

304 JOHNSON AVE
TEANECK NJ
07666-3151
US

V. Phone/Fax

Practice location:
  • Phone: 201-836-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00086400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberSI 03092
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ROBERT STAFFIN
Title or Position: CO-PRESIDENT
Credential: PSY.D.
Phone: 201-836-4055