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General NPI Number Information
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NPI Number | 1912430166
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Entity Type | Organization
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Legal Business Name | CENTER FOR ANXIETY AND BEHAVIOR MANAGEMENT, LLC
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 1 MILL RIDGE LN SUITE 209
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City | CHESTER
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State | NJ
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Zip | 07930-2488
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Country | US
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Telephone | 908-914-2624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21
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City | SCHOOLEYS MOUNTAIN
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State | NJ
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Zip | 07870-0021
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Country | US
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Telephone | 908-914-2624
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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. CASSANDRA M FARACI
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Credential | PSY.D.
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Telephone | 908-914-2624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35S100521400
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License Number State | NJ
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