Healthcare Provider Details

I. General information

NPI: 1720306111
Provider Name (Legal Business Name): CHRISTUS INSTITUTE FOR FAMILY LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MOUNTAIN CT STE 101B
HACKETTSTOWN NJ
07840-2300
US

IV. Provider business mailing address

PO BOX 7118
HACKETTSTOWN NJ
07840-7118
US

V. Phone/Fax

Practice location:
  • Phone: 908-455-1117
  • Fax:
Mailing address:
  • Phone: 908-455-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05363900
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. LAURENE LYNN CLOSSEY
Title or Position: MANAGING DIRECTOR
Credential: PHD
Phone: 908-455-1117