Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 35S100566400 | NJ |
Y | 103G00000X | Clinical Psychologist | 35S100566400 | NJ |
Y | 103TC0700X | Clinical Psychologist | 35S100566400 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 35S100566400 | NJ |
NPI | 1184162596 |
---|---|
Provider Name | Dr. Cara Church |
First Address | Highlands, NJ 07732 |
Second Address | Highlands, NJ 07732-1568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 06/02/2017 |