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General NPI Number Information
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NPI Number | 1841420841
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Entity Type | Organization
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Legal Business Name | MARCIA LAKY PHD
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 1330 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-4057
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Country | US
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Telephone | 973-633-1554
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Fax | 973-633-1564
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Provider Business Mailing Address
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Address Line | 1330 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-4057
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Country | US
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Telephone | 973-633-1554
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Fax | 973-633-1564
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. MARCIA LAKY
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Credential | PHD
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Telephone | 973-633-1554
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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 | 35SI00276700
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License Number State | NJ
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