Archetype Psychological Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ARCHETYPE PSYCHOLOGICAL SERVICES, LLC

Practice address

444 Northfield Ave
West Orange, NJ 07052-3012

Phone

(646) 820-5477

NPI assigned

Apr 18, 2019

Last updated

Apr 18, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Wendy Wilson-Poth, PHDNPI 1912439738

Title

Owner

Phone

(646) 820-5477

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, TX2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Wendy Diane Wilson-Poth, PH.D.

  • Clinical Psychologist
  • Netcong, NJ
  • NPI 1912439738

  TX

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555545600000",
    "number": "1952964611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ALLEN ST",
            "city": "NETCONG",
            "state": "NJ",
            "postal_code": "078571222",
            "telephone_number": "973-527-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 NORTHFIELD AVE",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "070523012",
            "telephone_number": "646-820-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARCHETYPE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-18",
        "last_updated": "2019-04-18",
        "status": "A",
        "authorized_official_last_name": "WILSON-POTH",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-820-5477",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee M. Arace, D.M.D.
• Hazel Lauron Araneta, PT, DPT
• Jose Araneta
• Elan Araten, DPT
• Arc of Essex County
• Arden Courts of W Orange NJ LLC (Arden Courts of West Orange)
• Ardent Home Healthcare
• Joanne Arduin, A.P.N.,C
• Melissa Arias
• Armac Inc (Armac Associates)

• Community/Behavioral Health Agency in West Orange, NJ
• Providers in West Orange, NJ by specialty
• Community/Behavioral Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2019; 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.