Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Prov 205 LLC

Organization Psychologist · NPI 1063963411

Prov 205 LLC is a Psychologist in Bayonne, New Jersey. Licensed in New Jersey. Registered with an NPI since 2016.

Licensed in
NJ
In the registry since
2016
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

866 Broadway Ste A
Bayonne, NJ 07002-3070
Phone: (201) 455-2052
Fax: (201) 354-9376
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence 35SI00437200 (NJ)

Record details

NPI number1063963411
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Joel Nunez — Psychologist · (201) 455-2052
NPI enumeratedOctober 20, 2016
Last updated in NPPESApril 27, 2017
Mailing addressPo Box 626, New Providence, NJ 07974-0626

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