MEDICARE: PSYCHOTHERAPY 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	103TC0700X	Clinical Psychologist	02791	NJ

General Provider Information

NPI Number	:	1750652665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOTHERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	42 E RAYBURN RD
Second Line	:
City	:	MILLINGTON
State	:	NJ
Zip	:	07946-1504
Country	:	US
Telephone Number	:	908-604-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 MORRISTOWN RD
Second Line	:	SUITE 215
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2626
Country	:	US
Telephone Number	:	908-306-0355
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SUSAN SOBEL ORSHAN
Credential	:
Telephone Number	:	908-604-9711

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	01/24/2013

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