| Mountain Lakes Psychotherapy, Llc | |
|
420 Boulevard Ste 109 Mountain Lakes NJ 07046-1733 | |
| (201) 710-4311 | |
| (973) 588-4655 |
| Full Name | Mountain Lakes Psychotherapy, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 420 Boulevard Ste 109, Mountain Lakes, New Jersey |
| Authorized Official Name and Position | Joanne R. Vannest (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 2017104311 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Lakes Psychotherapy, Llc 420 Boulevard Ste 109 Mountain Lakes NJ 07046-1733 Ph: (201) 710-4311 | Mountain Lakes Psychotherapy, Llc 420 Boulevard Ste 109 Mountain Lakes NJ 07046-1733 Ph: (201) 710-4311 |
| NPI Number | 1669943528 |
|---|---|
| Provider Enumeration Date | 12/17/2018 |
| Last Update Date | 12/17/2018 |
| Medicare PECOS PAC ID | 0244575942 |
|---|---|
| Medicare Enrollment ID | O20181228000674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669943528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Joanne Vannest |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245336460 PECOS PAC ID: 1052357167 Enrollment ID: I20050629000442 |
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