MEDICARE: HUDSON PSYCHOTHERAPY AND COPMLEMENTARY PRACTICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1235348376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUDSON PSYCHOTHERAPY AND COPMLEMENTARY PRACTICES, LLC

Provider Business Mailing Address
First Line	:	6811 BERGENLINE AVE
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-1807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6811 BERGENLINE AVE
Second Line	:
City	:	GUTTENBERG
State	:	NJ
Zip	:	07093-1807
Country	:	US
Telephone Number	:	201-861-6026
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANNET MOLINA-MANTEIGA
Credential	:	LCSW
Telephone Number	:	201-861-6026

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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