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General NPI Number Information
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NPI Number | 1386787612
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Entity Type | Organization
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Legal Business Name | SELECT PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 205 N FRANKLIN TPKE
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City | RAMSEY
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State | NJ
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Zip | 07446-1630
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Country | US
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Telephone | 201-327-7755
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Fax | 201-461-0089
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Provider Business Mailing Address
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Address Line | 205 N FRANKLIN TPKE
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City | RAMSEY
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State | NJ
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Zip | 07446-1630
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Country | US
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Telephone | 201-327-7755
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Fax | 201-461-0089
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. DENNIS DECICCO
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Credential | PH.D.
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Telephone | 201-327-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 3233
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License Number State | NJ
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