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General NPI Number Information
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NPI Number | 1871681221
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Entity Type | Organization
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Legal Business Name | ROANOKE PSYCHOLOGICAL SERVICES INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 71 SOUTH ORANGE AVE SUITE 350
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079
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Country | US
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Telephone | 646-942-6852
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Fax | 718-761-3094
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Provider Business Mailing Address
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Address Line | 71 SOUTH ORANGE AVE SUITE 350
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079
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Country | US
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Telephone | 646-942-6852
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Fax | 718-761-3094
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MICHELE GARNER
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Credential | LCSW
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Telephone | 646-942-6852
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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 | 3177
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License Number State | NJ
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