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General NPI Number Information
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NPI Number | 1568528388
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Entity Type | Organization
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Legal Business Name | PHOENIX PSYCHOLOGICAL ASSOCIATES INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 719 MAIN ST
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City | METUCHEN
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State | NJ
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Zip | 08840-1438
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Country | US
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Telephone | 732-501-2097
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Fax | 732-875-1053
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Provider Business Mailing Address
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Address Line | 719 MAIN ST
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City | METUCHEN
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State | NJ
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Zip | 08840-1438
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Country | US
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Telephone | 732-501-2097
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Fax | 732-875-1053
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, TREASURER
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Name | BARBARA A MACFIE
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Credential | LPC, MA, MDIV
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Telephone | 732-501-2097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00335400
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License Number State | NJ
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