Individual provider Active NPI

Elizabeth Mullen, PSYD

  • Clinical Psychologist
  • Passaic, NJ
National Provider Identifier
1821714031
Registry record updated Oct 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35SI00570800 Issued in NJ
Practice address
85 Crescent Ave
Passaic, NJ 07055-2437
Phone
(973) 264-0023
NPI assigned
Oct 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 35SI00570800 NJ Primary

Addresses

Primary practice location

85 Crescent Ave
Passaic, NJ 07055-2437

Mailing address

45 Wolfpack Rd
Trenton, NJ 08619-1350
Phone (570) 332-8140

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
I20221101001635 NJ Practitioner - Clinical Psychologist 2860869088 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Senior Care Therapy LLC Clinical CurrentSince Sep 1, 2022 Accepting new patients

Locations

2719 Hollywood Blvd
Hollywood, FL 33020
Phone (954) 354-2555

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": "1666137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666137600000",
    "number": "1821714031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 WOLFPACK RD",
            "city": "TRENTON",
            "state": "NJ",
            "postal_code": "086191350",
            "telephone_number": "570-332-8140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 CRESCENT AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070552437",
            "telephone_number": "973-264-0023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "ELIZABETH",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-19",
        "last_updated": "2022-10-19",
        "certification_date": "2022-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00570800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

Verify at the official NPI Registry.