Provider Demographics
NPI:1023148822
Name:PIERSON, ELLEN MCPEAK (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MCPEAK
Last Name:PIERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2442
Mailing Address - Country:US
Mailing Address - Phone:973-701-8113
Mailing Address - Fax:973-701-2189
Practice Address - Street 1:291 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2442
Practice Address - Country:US
Practice Address - Phone:973-701-8113
Practice Address - Fax:973-701-2189
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3219103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist