| Mjc Psychotherapy Services | |
|
622-624 Valley Road Suite 6c Upper Montclair NJ 07043 | |
| (201) 704-3164 | |
| (877) 615-7339 |
| Full Name | Mjc Psychotherapy Services |
|---|---|
| Speciality | Social Worker |
| Location | 622-624 Valley Road, Upper Montclair, New Jersey |
| Authorized Official Name and Position | Mary K. Culley (OWNER/PROVIDER) |
| Authorized Official Contact | 2017043164 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mjc Psychotherapy Services 622-624 Valley Road Suite 6c Upper Montclair NJ 07043 Ph: (201) 704-3164 | Mjc Psychotherapy Services 622-624 Valley Road Suite 6c Upper Montclair NJ 07043 Ph: (201) 704-3164 |
| NPI Number | 1457949190 |
|---|---|
| Provider Enumeration Date | 01/07/2021 |
| Last Update Date | 03/13/2023 |
| Certification Date | 03/13/2023 |
| Medicare PECOS PAC ID | 6406216928 |
|---|---|
| Medicare Enrollment ID | O20230716000087 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457949190 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mary Culley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467850586 PECOS PAC ID: 8426411216 Enrollment ID: I20230827000126 |
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