Healthcare Provider Details

I. General information

NPI: 1689188575
Provider Name (Legal Business Name): POSITIVE EDGE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 GRAND AVENUE
ENGLEWOOD NJ
07631
US

IV. Provider business mailing address

240 GRAND AVE
ENGLEWOOD NJ
07631-4352
US

V. Phone/Fax

Practice location:
  • Phone: 201-618-6911
  • Fax:
Mailing address:
  • Phone: 201-618-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LINDA ROSA
Title or Position: ADMINISTRATOR
Credential:
Phone: 201-281-8955