George Walton Ackley, PH.D., P.C.
Individual provider Active NPI Clinical Psychologist · Vineland, NJ
NPI 1457535833 · NPPES record last updated Sep 8, 2008
Key facts
- NPI
- 1457535833
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 35SI00302800 (NJ)
- Practice address
- 2848 S Delsea Dr
BLDG. B
Vineland, NJ 08360-7042 - Phone
- (609) 675-0872
- NPI assigned
- Dec 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35SI00302800 | NJ | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 35SI00302800 | NJ | Yes |
Addresses
Primary practice location
2848 S Delsea Dr
BLDG. B
Vineland, NJ 08360-7042
Mailing address
PO Box 339
Cape May Court House, NJ 08210-0339
Phone (609) 675-0872
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7158700 | Medicaid | NJ |
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All providers in Vineland, NJ · Clinical Psychologist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.