MEDICARE: DR. CAROL CHU-PERALTA PHD

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	020708	NY
2	103TC0700X	Clinical Psychologist	35SI00569400	NJ
3	103T00000X	Psychologist	020708	NY

General Provider Information

NPI Number	:	1467707067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL CHU-PERALTA PHD

Provider Business Mailing Address
First Line	:	160 SUMMIT AVE STE 205
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1763
Country	:	US
Telephone Number	:	201-661-3375
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 SUMMIT AVE STE 205
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1763
Country	:	US
Telephone Number	:	201-661-3375
Fax Number	:

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

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	12/18/2025

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