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General NPI Number Information
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NPI Number | 1134659410
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Entity Type | Organization
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Legal Business Name | DUCKETT & CHARLESTON PSYCHOLOGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1303 ROUTE 130 N
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City | BURLINGTON
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State | NJ
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Zip | 08016-2014
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Country | US
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Telephone | 609-456-1584
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 ROUTE 130 N
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City | BURLINGTON
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State | NJ
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Zip | 08016-2014
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Country | US
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Telephone | 609-456-1584
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/PSYCHOLOGIST
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Name | DR. JOY A. DUCKETT
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Credential | PSY.D.
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Telephone | 609-456-1584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 5241
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License Number State | NJ
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