Individual
EMIL AFFSA III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
655 E JERSEY ST, DEPT. OF BEHAVIORAL HEALTH & PSYCHIATRY, ELIZABETH, NJ 07206-1259
(908) 994-5000
(908) 994-5000
Mailing address
655 E JERSEY ST, DEPT. OF BEHAVIORAL HEALTH & PSYCHIATRY, ELIZABETH, NJ 07206-1259
(908) 994-5000
(908) 994-5000
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
37PC00333500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37PC0003335000
STATE LICENSE
NJ
Enumeration date
06/18/2007
Last updated
07/08/2007
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