| Elizabeth R Johannes Phd | |
|
37 Kings Rd Ste 201 Madison NJ 07940-2500 | |
| (862) 226-7285 | |
| (973) 628-4807 |
| Full Name | Elizabeth R Johannes Phd |
|---|---|
| Speciality | Clinic/Center |
| Location | 37 Kings Rd Ste 201, Madison, New Jersey |
| Authorized Official Name and Position | Elizabeth R. Johannes (PSYCHOTHERAPIST) |
| Authorized Official Contact | 8622267285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elizabeth R Johannes Phd 65 Chapel Hill Rd Lincoln Park NJ 07035-1918 Ph: (862) 226-7285 | Elizabeth R Johannes Phd 37 Kings Rd Ste 201 Madison NJ 07940-2500 Ph: (862) 226-7285 |
| NPI Number | 1043736515 |
|---|---|
| Provider Enumeration Date | 08/16/2017 |
| Last Update Date | 12/08/2021 |
| Certification Date | 12/08/2021 |
| Medicare PECOS PAC ID | 2567704828 |
|---|---|
| Medicare Enrollment ID | O20190507001294 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043736515 | NPI | - | NPPES |
| 1669844262 | Other | NJ | NATIONAL PROVIDER IDENTIFICATION 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 44SC05654600 (New Jersey) | Primary |
| Provider Name | Elizabeth Redegeld Johannes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669844262 PECOS PAC ID: 5799086740 Enrollment ID: I20151216000016 |
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