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General NPI Number Information
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NPI Number | 1265840441
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Entity Type | Individual
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Provider Name | LYSANDRA M PEREZ-STRUMOLO PHD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 225 ROUTE 23 NORTH SUITE 2B
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City | HAMBURG
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State | NJ
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Zip | 07419
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Country | US
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Telephone | 973-864-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 357 BOULEVARD
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City | POMPTON PLAINS
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State | NJ
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Zip | 07444-1311
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Country | US
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Telephone | 862-377-4267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TP#143-048
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License Number State | NJ
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