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General NPI Number Information
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NPI Number | 1144832528
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Entity Type | Organization
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Legal Business Name | PRINCETON PSYCHOLOGICAL LLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 321 ROGERS ST
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City | PRINCETON
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State | WV
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Zip | 24740-3639
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Country | US
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Telephone | 304-308-3819
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5509
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City | PRINCETON
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State | WV
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Zip | 24740-5509
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Country | US
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Telephone | 304-308-3819
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY JO CECIL
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Credential | MA
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Telephone | 304-308-3819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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