Provider Demographics
NPI: | 1053763375 |
---|---|
Name: | OAK PSYCHOLOGICAL SERVICES, LLC |
Entity type: | Organization |
Organization Name: | OAK PSYCHOLOGICAL SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PSYCHOLOGIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ERIKA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | OAK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD |
Authorized Official - Phone: | 201-961-3092 |
Mailing Address - Street 1: | 20 WALDMERE PL |
Mailing Address - Street 2: | |
Mailing Address - City: | WALDWICK |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07463-1109 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 201-961-3092 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 19 SPEAR RD |
Practice Address - Street 2: | SUITE 201 |
Practice Address - City: | RAMSEY |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07446-1235 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-961-3092 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-07-11 |
Last Update Date: | 2016-07-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 5556 | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty |