Basic Information
| Provider Information | |||||||||
| NPI: | 1003284332 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REA | ||||||||
| FirstName: | CLEVELAND | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 E LAUREL RD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565666034 | ||||||||
| FaxNumber: | 8565666208 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 E LAUREL RD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STRATFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080841324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565666034 | ||||||||
| FaxNumber: | 8565666208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 35SI00380900 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.