Provider Demographics
NPI:1902907660
Name:FREEHOLD PSYCHOLOGY GROUP
Entity Type:Organization
Organization Name:FREEHOLD PSYCHOLOGY GROUP
Other - Org Name:OCEAN PSYCHOLOGICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-780-9898
Mailing Address - Street 1:149 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2051
Mailing Address - Country:US
Mailing Address - Phone:732-780-9898
Mailing Address - Fax:732-780-6447
Practice Address - Street 1:149 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2051
Practice Address - Country:US
Practice Address - Phone:732-780-9898
Practice Address - Fax:732-780-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFR583199Medicare ID - Type Unspecified