Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 35S100452200 | NJ |
Y | 103TC0700X | Clinical Psychologist | 35S100452200 | NJ |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TF0200X | Forensic Psychologist | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1669800900 |
---|---|
Provider Name | Nicole De Vita |
First Address | Cedar Grove, NJ 07009-1436 |
Second Address | Cedar Grove, NJ 07009-1436 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2013 |
Last Update Date | 24/10/2013 |