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General NPI Number Information
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NPI Number | 1023990041
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Entity Type | Organization
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Legal Business Name | JERSEY PSYCH LLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 501 ROUTE 17 STE 1- 1160
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City | PARAMUS
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State | NJ
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Zip | 07652
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Country | US
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Telephone | 201-523-2129
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Fax |
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Provider Business Mailing Address
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Address Line | 501 ROUTE 17 STE 1- 1160
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City | PARAMUS
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State | NJ
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Zip | 07652
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Country | US
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Telephone | 201-523-2129
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | DIANE SOSA
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Credential |
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Telephone | 201-523-2129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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