| The Psych Center Llc | |
|
103 River Rd Ste 101 Edgewater NJ 07020-1016 | |
| (201) 308-8995 | |
| Not Available |
| Full Name | The Psych Center Llc |
|---|---|
| Speciality | Psychologist |
| Location | 103 River Rd Ste 101, Edgewater, New Jersey |
| Authorized Official Name and Position | Brian Legg (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2019882388 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Psych Center Llc 103 River Rd Ste 101 Edgewater NJ 07020-1016 Ph: (201) 308-8995 | The Psych Center Llc 103 River Rd Ste 101 Edgewater NJ 07020-1016 Ph: (201) 308-8995 |
| NPI Number | 1720435654 |
|---|---|
| Provider Enumeration Date | 05/20/2016 |
| Last Update Date | 03/14/2017 |
| Medicare PECOS PAC ID | 0446527261 |
|---|---|
| Medicare Enrollment ID | O20170530000647 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720435654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | PC006208 (Pennsylvania) | Secondary |
| 103TC0700X | Psychologist - Clinical | 5576 (New Jersey) | Primary |
| Provider Name | Emad Mounir |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598899015 PECOS PAC ID: 5294049151 Enrollment ID: I20150805008389 |
| Provider Name | Brian Legg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1114399383 PECOS PAC ID: 9537448782 Enrollment ID: I20161111000660 |
| Provider Name | Thomas S Larson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114170909 PECOS PAC ID: 5698016699 Enrollment ID: I20190401000016 |
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