=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619578002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MC COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2020
-----------------------------------------------------
Last Update Date | 11/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 SHARON DRIVE
-----------------------------------------------------
City | EAST HANOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-306-8794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 HILLSIDE DRIVE
-----------------------------------------------------
City | EAST HANOVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-306-8794
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | MICHELLE CUPPARI
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 862-306-8794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------