Mountain Lakes Psychotherapy, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

MOUNTAIN LAKES PSYCHOTHERAPY, LLC

Practice address

420 Boulevard Ste 109
Mountain Lakes, NJ 07046-1733

Phone

(201) 710-4311

Fax

(973) 588-4655

NPI assigned

Dec 17, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Joanne R. Vannest, PH.D.NPI 1245336460

Title

Psychologist/Owner

Phone

(201) 710-4311

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

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

• Joanne R Vannest, PH.D.

  • Clinical Psychologist
  • Livingston, NJ
  • NPI 1245336460

  NJ

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1669943528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD STE 109",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461733",
            "telephone_number": "201-710-4311",
            "fax_number": "973-588-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 BOULEVARD STE 109",
            "city": "MOUNTAIN LAKES",
            "state": "NJ",
            "postal_code": "070461733",
            "telephone_number": "201-710-4311",
            "fax_number": "973-588-4655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN LAKES PSYCHOTHERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "VANNEST",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PSYCHOLOGIST/OWNER",
        "authorized_official_telephone_number": "201-710-4311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Lakes Family Practice LLC
• Mountain Lakes Integrated Healthcare
• Mountain Lakes Medical Center, LLC
• Mountain Lakes Pathology LLC
• Mountain Lakes Premier Dental , LLC
• Mpower Physical Therapy LLC
• MTB First Assist LLC
• Sheikh Marie Naeem, MD
• Elizabeth Niewood
• Anjalee Sriram Nirgudkar, PH. D., BCBA-D

• All providers in Mountain Lakes, NJ
• Community/Behavioral Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.