| Organization Name: | ELDEROLOGY, LLC |
| NPI Number: | 1790931269 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CYNTHIA ANN PUCHAMMER (EXECUTIVE DIRECTOR) |
| Mailing Address: | 31 Carsam St Fanwood |
| State: | NJ US |
| Postal Code: | 070231609 |
| Phone Number: | 9088890714 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2008 |
| NPI Last Update Date: | 08/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 44SC05307500 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |