Provider Demographics
NPI:1730249574
Name:LINEHAN, EDWARD JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:LINEHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W. 95TH STREET
Mailing Address - Street 2:APT #71
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8522
Mailing Address - Country:US
Mailing Address - Phone:973-769-5881
Mailing Address - Fax:
Practice Address - Street 1:523 SERGEANTSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-2703
Practice Address - Country:US
Practice Address - Phone:973-769-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1718103TC0700X, 103T00000X
NJ355100171800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4669304Medicaid
NJIS451OtherOXFORD
NJ270811000OtherMAGELLAN