Individual provider Active NPI

Joyce Fichtenbaum, PHD.

  • Psychologist
  • West Orange, NJ
National Provider Identifier
1801884176
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
35SI00328800 Issued in NJ
Practice address
1199 Pleasant Valley Way
West Orange, NJ 07052-1424
Phone
(973) 731-3600
NPI assigned
Oct 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 35SI00328800 NJ Primary

Addresses

Primary practice location

1199 Pleasant Valley Way
West Orange, NJ 07052-1424

Mailing address

120 Ridge Dr
Montville, NJ 07045-9473
Phone (862) 812-3864

Other identifiers 1

IdentifierTypeStateIssuer
0056731MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050218000171 NJ Practitioner - Clinical Psychologist 1254383177 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
35SI00328800NJMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
JKF Consulting Psychologist CurrentSince Aug 1, 2018 Accepting new patients

Locations

1199 Pleasant Valley Way
West Orange, NJ 07052
Phone (973) 414-4755

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597104000000",
    "number": "1801884176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RIDGE DR",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070459473",
            "telephone_number": "862-812-3864",
            "fax_number": "973-265-4851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1199 PLEASANT VALLEY WAY",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070521424",
            "telephone_number": "973-731-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FICHTENBAUM",
        "first_name": "JOYCE",
        "credential": "PHD.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-11",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "35SI00328800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0056731",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Orange, NJ

Sources for this page

Verify at the official NPI Registry.