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General NPI Number Information
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NPI Number | 1497186126
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Entity Type | Organization
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Legal Business Name | PSYCHODRAMA NEW JERSEY LLC
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Dates
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Enumeration Date | 12/05/2013
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Last Update Date | 12/05/2013
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Provider Practice Location Address
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Address Line | 1806 HIGHWAY 35
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City | OAKHURST
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State | NJ
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Zip | 07755-2700
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Country | US
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Telephone | 732-221-7306
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3063
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City | LONG BRANCH
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State | NJ
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Zip | 07740-3063
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/OWNER
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Name | MRS. LUCY SCOTT URMEY
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Credential | MSW, LCSW, CP
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Telephone | 732-221-7306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC05441500
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License Number State | NJ
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