Healthcare Provider Details

I. General information

NPI: 1376663096
Provider Name (Legal Business Name): COMPREHENSIVE PSYCHOLOGY SYSTEM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 STATE ROUTE 66 STE 331
TINTON FALLS NJ
07753-7300
US

IV. Provider business mailing address

4000 ROUTE 66 STE 331
TINTON FALLS NJ
07753-7300
US

V. Phone/Fax

Practice location:
  • Phone: 732-988-4431
  • Fax: 732-988-7123
Mailing address:
  • Phone: 732-988-3441
  • Fax: 732-988-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3SS100151900
License Number StateNJ

VIII. Authorized Official

Name: ANITA CATHERINE WATKINS-SICA
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-988-3441