Healthcare Provider Details

I. General information

NPI: 1114374550
Provider Name (Legal Business Name): TOLCHIN PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 TAYLOR DR
WEST CALDWELL NJ
07006-6918
US

IV. Provider business mailing address

31 TAYLOR DR
WEST CALDWELL NJ
07006-6918
US

V. Phone/Fax

Practice location:
  • Phone: 973-228-1394
  • Fax:
Mailing address:
  • Phone: 973-228-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number35SI00490200
License Number StateNJ

VIII. Authorized Official

Name: DR. NICHOLAS TOLCHIN
Title or Position: OWNER
Credential: PHD
Phone: 973-224-5028