| Wellqor Psychological Services Northeast, Pc | |
|
1001 Raritan Ave Highland Park NJ 08904-3667 | |
| (732) 991-1540 | |
| Not Available |
| Full Name | Wellqor Psychological Services Northeast, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1001 Raritan Ave, Highland Park, New Jersey |
| Authorized Official Name and Position | Peter Vietze (OWNER) |
| Authorized Official Contact | 3476684992 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellqor Psychological Services Northeast, Pc 135 Pinelawn Rd Ste 204n Melville NY 11747-3133 Ph: (516) 987-4200 | Wellqor Psychological Services Northeast, Pc 1001 Raritan Ave Highland Park NJ 08904-3667 Ph: (732) 991-1540 |
| NPI Number | 1326442567 |
|---|---|
| Provider Enumeration Date | 10/17/2014 |
| Last Update Date | 06/08/2020 |
| Certification Date | 06/08/2020 |
| Medicare PECOS PAC ID | 7618299116 |
|---|---|
| Medicare Enrollment ID | O20141212000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326442567 | NPI | - | NPPES |
| 017065 | Other | NY | PROFESSIONAL LICENSE |
| 35SI00517600 | Other | NJ | PROFESSIONAL LICENSE |
| Provider Name | Kathleen S Galasso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003306689 PECOS PAC ID: 7810944394 Enrollment ID: I20050406000915 |
| Provider Name | Jennifer Marchese Tumminello |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063444701 PECOS PAC ID: 7810933538 Enrollment ID: I20050706000164 |
| Provider Name | Peter Vietze |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235266016 PECOS PAC ID: 8426156902 Enrollment ID: I20141212000974 |
| Provider Name | Scott M Banford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336485465 PECOS PAC ID: 2961719778 Enrollment ID: I20150910002693 |
| Provider Name | Dalia M Lightman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548628373 PECOS PAC ID: 3577869320 Enrollment ID: I20160304001010 |
| Provider Name | Urmi P Vaidya Mathur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861780736 PECOS PAC ID: 7911160221 Enrollment ID: I20160321002130 |
| Provider Name | Ann Wallace-frick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669922514 PECOS PAC ID: 4981982436 Enrollment ID: I20161103001196 |
| Provider Name | Robin J Cohn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265694178 PECOS PAC ID: 4789826124 Enrollment ID: I20170125001533 |
| Provider Name | Jesse Glassman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871965392 PECOS PAC ID: 6002187325 Enrollment ID: I20170804002269 |
| Provider Name | Benjamin Gottesman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174805709 PECOS PAC ID: 3870865843 Enrollment ID: I20190123000919 |
| Provider Name | Amanda Jean Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508080318 PECOS PAC ID: 2668530486 Enrollment ID: I20231128003530 |
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