Healthcare Provider Details

I. General information

NPI: 1336719368
Provider Name (Legal Business Name): R.E.A.L. THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS TOWN CIR STE 103
EWING NJ
08638-1962
US

IV. Provider business mailing address

566 BELLEVUE AVE
TRENTON NJ
08618-4402
US

V. Phone/Fax

Practice location:
  • Phone: 609-552-7325
  • Fax: 609-594-1200
Mailing address:
  • Phone: 609-963-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TIANA SAVAGE
Title or Position: OWNER/PRESIDENT
Credential: LCSW
Phone: 609-963-5051