Provider Demographics
NPI:1447873781
Name:ELEMENTS PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:ELEMENTS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-383-5056
Mailing Address - Street 1:210 SUMMIT AVE STE C-2A
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1579
Mailing Address - Country:US
Mailing Address - Phone:201-383-5056
Mailing Address - Fax:
Practice Address - Street 1:210 SUMMIT AVE STE C-2A
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1579
Practice Address - Country:US
Practice Address - Phone:201-383-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty