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Avicenna Medical Center
Prescribing (Medical) Psychologist in Montclair, New Jersey
NPI 1073904801

Avicenna Medical Center is a Prescribing (Medical) Psychologist based in Montclair, NJ and is specialized in Prescribing (Medical). Avicenna Medical Center practices in Montclair, NJ. The NPI Number for Avicenna Medical Center is 1073904801 and holds a License No. 25MB07627000 (New Jersey).

The current practice location address for Avicenna Medical Center is 129 Valley Rd, Montclair, NJ and can be reached out via phone at 973-746-2620 and via fax at 973-746-2579.

Location: 129 Valley Rd, Montclair, NJ, 07042-2331
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1073904801
Provider Name
Avicenna Medical Center
Credential
Provider Entity Type
Organization
Address
129 Valley Rd, Montclair, NJ, 07042-2331
Phone Number
973-746-2620
Fax Number
973-746-2579
Provider Enumeration Date
02/16/2015
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
129 Valley Rd
City
Montclair
State
New Jersey
Zip
07042-2331
Phone Number
973-746-2620
Fax Number
973-746-2579
person
Provider Business Mailing Address Details
Address
129 Valley Rd
City
Montclair
State
New Jersey
Zip
07042-2331
Phone Number
973-746-2620
Fax Number
973-746-2579
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Psychologist
Speciality
Prescribing (Medical)
Taxonomy
103TP0016X
License No.
25MB07627000 (New Jersey)
Definition
A licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended.
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