NPIMap

Organization Active NPI

MCCD NJ Psychiatry Services PLLC

  • Psychiatry Physician
  • Marlton, NJ
National Provider Identifier
1619638822
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MCCD NJ PSYCHIATRY SERVICES PLLC
Practice address
525 Route 73 N Ste 117
Marlton, NJ 08053-3422
Phone
(833) 351-8255
NPI assigned
Jan 10, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Dr. Georgia Gaveras, DO
Title
Ceo/Chief Medical Officer
Phone
(917) 309-7915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

525 Route 73 N Ste 117
Marlton, NJ 08053-3422

Mailing address

109 W 27TH St Ste 5S
New York, NY 10001-6208
Phone (917) 634-5311

National Provider Directory

National Provider Directory

Locations

109 W 27th St
New York, NY 10001
Phone (332) 206-6054

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1619638822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 W 27TH ST STE 5S",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100016208",
            "telephone_number": "917-634-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ROUTE 73 N STE 117",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080533422",
            "telephone_number": "833-351-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCD NJ PSYCHIATRY SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-10",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "GAVERAS",
        "authorized_official_first_name": "GEORGIA",
        "authorized_official_title_or_position": "CEO/CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "917-309-7915",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.