=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366843997
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI STEPHANIE HUNTINGTON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2014
-----------------------------------------------------
Last Update Date | 09/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 RAMAPO VALLEY RD
-----------------------------------------------------
City | MAHWAH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07430-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-476-6342
-----------------------------------------------------
Fax | 201-961-6846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 RAMAPO VALLEY RD
-----------------------------------------------------
City | MAHWAH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07430-2403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-476-6342
-----------------------------------------------------
Fax | 201-961-6846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 35S100534900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 020564
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 46TR00266100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 019091-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------