Healthcare Provider Details

I. General information

NPI: 1124421144
Provider Name (Legal Business Name): PATHWAY PERSONAL COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2014
Last Update Date: 10/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3119
US

IV. Provider business mailing address

781 8TH ST
SECAUCUS NJ
07094-3343
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-6597
  • Fax:
Mailing address:
  • Phone: 201-981-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number44SC05359300
License Number StateNJ

VIII. Authorized Official

Name: MRS. MARISA HAMILTON
Title or Position: OWNER
Credential: LCSW
Phone: 201-245-1166