Montclair Memory Clinic LLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

35SI00390000 Issued in NJ

Legal business name

MONTCLAIR MEMORY CLINIC LLC

Practice address

70 Park Street
Suite 207
Montclair, NJ 07042-2960

Phone

(973) 743-4555

Fax

(973) 743-4055

NPI assigned

Sep 23, 2015

Last updated

Apr 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacqueline A Rondeau, PSYDNPI 1285622217

Title

Clinical Director

Phone

(973) 743-4555

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacqueline Ann Rondeau, PSY.D.

  • Clinical Psychologist
  • Montclair, NJ
  • NPI 1285622217

  Clinical Neuropsychologist

  Medicare reassignment NPD Authorized official
• Elizabet Santana Marmonhalm, PSY.D.

  • Clinical Neuropsychologist
  • Montclair, NJ
  • NPI 1487282901
  Medicare reassignment NPD

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460678400000",
    "number": "1114396835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8121",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070288121",
            "telephone_number": "973-743-4555",
            "fax_number": "973-743-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 PARK STREET",
            "address_2": "SUITE 207",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422960",
            "telephone_number": "973-743-4555",
            "fax_number": "973-743-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTCLAIR MEMORY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-23",
        "last_updated": "2016-04-15",
        "status": "A",
        "authorized_official_last_name": "RONDEAU",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "973-743-4555",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NJ",
            "license": "35SI00390000",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00390000",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0051560",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Montclair Hospital, LLC (Hackensack UMC Mountainside)
• Montclair Pathology Associates, PA
• Montclair Pediatrics
• Montclair Performance Health and Chiropractic Inc
• Montclair Physical Therapy Associates PA
• Montclair Physicians Group

• Clinical Neuropsychologist in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Clinical Neuropsychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2016; 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.