MONTCLAIR MEMORY CLINIC LLC NPI 1114396835

NPI Information

  • NPI: 1114396835
  • Provider Name: MONTCLAIR MEMORY CLINIC LLC
  • Classification: Clinical Neuropsychologist - 103G00000X
  • Entity Type: Organization
  • CLIA Number: 31D2131515
  • Address: 70 PARK STREET
    SUITE 207
    MONTCLAIR, NJ
    ZIP 07042
  • Phone: (973) 743-4555

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NPI Details

MONTCLAIR MEMORY CLINIC LLC is a clinical neuropsychologist in Montclair, NJ. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. MONTCLAIR MEMORY CLINIC LLC NPI is 1114396835. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

70 PARK STREET
SUITE 207
MONTCLAIR, NJ
ZIP 07042-960
Phone: (973) 743-4555
Fax: (973) 743-4055

The provider's authorized official is Jacqueline A Rondeau .
The authorized official title is Clinical Director and has the following contact phone number (973) 743-4555.

The CLIA number assigned to this NPI record is 31D2131515 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/23/2015 and was last updated on 4/15/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TC0700XPsychologistClinical35SI00390000NEW JERSEYNo
2235Z00000XSpeech-Language PathologistNo
3103G00000XClinical Neuropsychologist35SI00390000NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1049043MEDICARE PINNEW JERSEY
20051560MEDICAIDNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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