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General NPI Number Information
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NPI Number | 1255508842
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Entity Type | Organization
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Legal Business Name | CLINICAL PSYCHOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 40 AVENUE AT THE CMN SUITE 203
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4800
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Country | US
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Telephone | 732-544-9079
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Fax | 732-544-9079
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Provider Business Mailing Address
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Address Line | 40 AVE AT THE COMMON SUITE 203
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City | SHREWSBURY
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State | NJ
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Zip | 07704
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Country | US
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Telephone | 732-544-9079
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Fax | 732-544-9079
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RICHARD SCOTT ZAKRESKI
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Credential | PHD
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Telephone | 732-544-9079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 1922
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License Number State | NJ
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