Healthcare Provider Details

I. General information

NPI: 1932982725
Provider Name (Legal Business Name): HOPSCOTCH HEALTH OF NJ PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10265 ROCKINGHAM DR STE 100
SACRAMENTO CA
95827-2566
US

IV. Provider business mailing address

447 BROADWAY 2ND FL 687
NEW YORK NY
10013
US

V. Phone/Fax

Practice location:
  • Phone: 617-333-8740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARLA BEYER
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 617-333-8740