Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35SI00380900 | NJ |
Y | 103T00000X | Psychologist | 35SI00380900 | NJ |
NPI | 1003284332 |
---|---|
Provider Name | Cleveland D. Rea JR. |
First Address | Stratford, NJ 08084-1324 |
Second Address | Stratford, NJ 08084-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 03/09/2015 |