Basic Information
| Provider Information | |||||||||
| NPI: | 1942518238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | XIQUES | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ELENA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSY.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 59 KOCH AVENUE | ||||||||
| Address2: | GREYSTONE PARK PSYCHIATRIC HOSPITAL | ||||||||
| City: | MORRIS PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735381800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 59 KOCH AVENUE | ||||||||
| Address2: | GREYSTONE PARK PSYCHIATRIC HOSPITAL | ||||||||
| City: | MORRIS PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735381800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2010 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 4760 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TM1800X | 4760 | NJ | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
No ID Information.