MEDICARE: HASSON PSYCHOLOGICAL GROUP 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	103G00000X	Clinical Neuropsychologist	2493	NJ

General Provider Information

NPI Number	:	1730118571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HASSON PSYCHOLOGICAL GROUP LLC

Provider Business Mailing Address
First Line	:	185 ENGLE ST FL 2
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2409
Country	:	US
Telephone Number	:	201-568-1111
Fax Number	:	201-568-1855

Provider Business Practice Location Address
First Line	:	185 ENGLE ST FL 2
Second Line	:
City	:	ENGLEWOOD
State	:	NJ
Zip	:	07631-2409
Country	:	US
Telephone Number	:	201-568-1111
Fax Number	:	201-568-1855

Authorized Official
Title or Position	:	LIC. PSYCHOLOGIST OWNER
Name	:	DR. CHARLES STEWART HASSON
Credential	:	PH.D LIC. PSYCHOLOGI
Telephone Number	:	201-568-1111

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	04/10/2012

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