Healthcare Provider Details

I. General information

NPI: 1073705703
Provider Name (Legal Business Name): JOY L. HUSTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 UPPER MONTCLAIR PLZ SUITE 29
UPPER MONTCLAIR NJ
07043-1343
US

IV. Provider business mailing address

51 UPPER MONTCLAIR PLZ SUITE 29
UPPER MONTCLAIR NJ
07043-1343
US

V. Phone/Fax

Practice location:
  • Phone: 201-213-9573
  • Fax: 973-281-9047
Mailing address:
  • Phone: 201-213-9573
  • Fax: 973-281-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4225
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4225
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4225
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4225
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4225
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number4225
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: