MEDICARE: MD PSYCHOLOGICAL SERVICES LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1265329627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	17 8TH ST
Second Line	:
City	:	HAZLET TWP
State	:	NJ
Zip	:	07734-3039
Country	:	US
Telephone Number	:	732-687-3591
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 8TH ST
Second Line	:
City	:	HAZLET TWP
State	:	NJ
Zip	:	07734-3039
Country	:	US
Telephone Number	:	732-687-3591
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MELISSA DONADIO
Credential	:	PSY.D
Telephone Number	:	732-687-3591

Provider Enumeration Date	:	06/19/2025
Last Update Date	:	06/19/2025

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