=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679635114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PSYCHOLOGICAL HEALTH SERVICES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 363 HAMILTON AVE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08609-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-396-3491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 363 HAMILTON AVE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08609-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-396-3491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ELLEN R FINK
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 609-396-3491
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 35SI00178800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------