Healthcare Provider Details

I. General information

NPI: 1184283921
Provider Name (Legal Business Name): OPEN ARMS THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BRICK BLVD STE 204
BRICK NJ
08723-6079
US

IV. Provider business mailing address

445 BRICK BLVD STE 204
BRICK NJ
08723-6079
US

V. Phone/Fax

Practice location:
  • Phone: 732-600-9356
  • Fax:
Mailing address:
  • Phone: 732-600-9356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY VEGA SR.
Title or Position: PSYCHOTHERAPIST
Credential: L.C.S.W, MSW
Phone: 732-600-9356