Healthcare Provider Details

I. General information

NPI: 1407953896
Provider Name (Legal Business Name): SPECIALIZED THERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SUMMIT AVE
HACKENSACK NJ
07601-1262
US

IV. Provider business mailing address

83 SUMMIT AVE
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-6678
  • Fax: 201-224-0599
Mailing address:
  • Phone: 201-488-6678
  • Fax: 201-224-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. VANESSA GOURDINE
Title or Position: CLINICAL DIRECTOR
Credential: PSY. D.
Phone: 201-488-6678