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General NPI Number Information
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NPI Number | 1609026830
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Entity Type | Organization
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Legal Business Name | EPHATHA MENTAL HEALTH ASSOCIATES PC
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Dates
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Enumeration Date | 09/24/2008
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 566 GRAND AVE
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-1504
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Country | US
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Telephone | 201-313-8000
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Fax | 201-313-8002
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Provider Business Mailing Address
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Address Line | 566 GRAND AVE
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City | RIDGEFIELD
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State | NJ
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Zip | 07657-1504
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Country | US
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Telephone | 201-313-8000
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Fax | 201-313-8002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEUNG H LEE
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Credential |
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Telephone | 201-313-8000
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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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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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