MEDICARE: MICHAEL OVERLAND PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	SI03685	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	053710	OTHER	NJ	VALUE OPTIONS
2	P1219024	OTHER	NJ	OXFORD
3	460217000	OTHER	NJ	MAGELLAN

General Provider Information

NPI Number	:	1255498382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL OVERLAND PH.D.

Provider Business Mailing Address
First Line	:	513 W MOUNT PLEASANT AVE
Second Line	:	SUITE 306
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1710
Country	:	US
Telephone Number	:	973-994-1101
Fax Number	:	973-994-1101

Provider Business Practice Location Address
First Line	:	513 W MOUNT PLEASANT AVE
Second Line	:	SUITE 306
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1710
Country	:	US
Telephone Number	:	973-994-1101
Fax Number	:	973-994-1101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	12/11/2016

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Directions to “ MICHAEL OVERLAND PH.D.” Practice Location

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