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General NPI Number Information
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NPI Number | 1700042074
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Entity Type | Organization
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Legal Business Name | PRINCETON PSYCHOLOGICAL CENTER
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 9 CHARLTON ST
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City | PRINCETON
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State | NJ
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Zip | 08540-5231
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Country | US
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Telephone | 609-658-0368
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CHARLTON ST
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City | PRINCETON
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State | NJ
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Zip | 08540-5231
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Country | US
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Telephone | 609-658-0368
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CRAIG MATTHEW CALLAN
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Credential | PSY.D.
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Telephone | 732-735-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4521
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4191
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License Number State | NJ
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