Healthcare Provider Details

I. General information

NPI: 1558025791
Provider Name (Legal Business Name): COLLABORATIVE THERAPY NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 MAIN ST
CHESTER NJ
07930-2526
US

IV. Provider business mailing address

409 MAIN ST
CHESTER NJ
07930-2526
US

V. Phone/Fax

Practice location:
  • Phone: 908-666-0991
  • Fax: 908-888-2209
Mailing address:
  • Phone: 908-666-0991
  • Fax: 908-888-2209

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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARIE HARTZEL
Title or Position: ADMINISTRATOR
Credential: LPC, LCADC
Phone: 201-787-6637