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General NPI Number Information
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NPI Number | 1447873781
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Entity Type | Organization
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Legal Business Name | ELEMENTS PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 210 SUMMIT AVE STE C-2A
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City | MONTVALE
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State | NJ
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Zip | 07645-1579
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Country | US
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Telephone | 201-383-5056
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Fax |
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Provider Business Mailing Address
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Address Line | 210 SUMMIT AVE STE C-2A
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City | MONTVALE
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State | NJ
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Zip | 07645-1579
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Country | US
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Telephone | 201-383-5056
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JESSICA AMELIA MCCARTHY
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Credential |
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Telephone | 201-383-5056
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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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