Provider Demographics
| NPI: | 1053763375 |
|---|---|
| Name: | OAK PSYCHOLOGICAL SERVICES, LLC |
| Entity type: | Organization |
| Organization Name: | OAK PSYCHOLOGICAL SERVICES, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PSYCHOLOGIST |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | ERIKA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | OAK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PSYD |
| Authorized Official - Phone: | 201-961-3092 |
| Mailing Address - Street 1: | 20 WALDMERE PL |
| Mailing Address - Street 2: | |
| Mailing Address - City: | WALDWICK |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 07463-1109 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 201-961-3092 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 19 SPEAR RD |
| Practice Address - Street 2: | SUITE 201 |
| Practice Address - City: | RAMSEY |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 07446-1235 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 201-961-3092 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2016-07-11 |
| Last Update Date: | 2016-07-11 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NJ | 5556 | 103T00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty |