Organization Active NPI

Craig W. Pearl, Psy.D., P.C.

  • Clinical Psychologist
  • Mount Laurel, NJ
National Provider Identifier
1043320104
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CRAIG W. PEARL, PSY.D., P.C.
Practice address
3804 Church Rd
Mount Laurel, NJ 08054-1106
Phone
(856) 778-2100
Fax
(856) 787-9588
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Eugenia Warhol Skuby
Title
Office Manager
Phone
(856) 778-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

3804 Church Rd
Mount Laurel, NJ 08054-1106

Mailing address

3804 Church Rd
Mount Laurel, NJ 08054-1106
Phone (856) 778-2100

Other identifiers 1

IdentifierTypeStateIssuer
7406401MedicaidNJ

Other names 1

  • Pearl Prof Psych Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031126000529 NJ Part B Supplier - Clinic/Group Practice 6002711496 Receives reassigned benefits from 2 practitioners
Practice locations: Moorestown, NJ; Mount Laurel, NJ

National Provider Directory

National Provider Directory

Locations

3747 Church Rd
Ste 100
Mount Laurel, NJ 08054
Phone (609) 778-2100

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1043320104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3804 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541106",
            "telephone_number": "856-778-2100",
            "fax_number": "856-787-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3804 CHURCH RD",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541106",
            "telephone_number": "856-778-2100",
            "fax_number": "856-787-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAIG W. PEARL, PSY.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "SKUBY",
        "authorized_official_first_name": "EUGENIA",
        "authorized_official_middle_name": "WARHOL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "856-778-2100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7406401",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pearl Prof Psych Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Laurel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.