Organization
PROV 205 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL NUNEZ PH.D. (PSYCHOLOGIST)
(201) 455-2052
Entity
Organization
Contact information
Practice address
866 BROADWAY, SUITE A, BAYONNE, NJ 07002-3070
(201) 455-2052
(201) 354-9376
Mailing address
PO BOX 626, NEW PROVIDENCE, NJ 07974-0626
(201) 455-2052
(201) 354-9376
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
35SI00437200
NJ
Other
Enumeration date
10/20/2016
Last updated
04/27/2017
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