MEDICARE: SENIOR CARE THERAPY OF VIRGINIA, 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	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1265017180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CARE THERAPY OF VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	85 CRESCENT AVE
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-2437
Country	:	US
Telephone Number	:	973-264-0023
Fax Number	:	973-264-0022

Provider Business Practice Location Address
First Line	:	2045 S PLEASANT VALLEY RD # 1002
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22601-7001
Country	:	US
Telephone Number	:	973-264-0023
Fax Number	:	973-264-0022

Authorized Official
Title or Position	:	OWNER
Name	:	ROSENFELD ALISA
Credential	:	LCSW
Telephone Number	:	973-264-0023

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	03/12/2021

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