Healthcare Provider Details

I. General information

NPI: 1851594790
Provider Name (Legal Business Name): THE CHILDREN'S THERAPY CENTER OF NORTH JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 QUARRY RD SUITE 2
HAMBURG NJ
07419-1339
US

IV. Provider business mailing address

100 QUARRY RD SUITE 2
HAMBURG NJ
07419-1339
US

V. Phone/Fax

Practice location:
  • Phone: 973-209-4064
  • Fax: 973-209-4867
Mailing address:
  • Phone: 973-209-4064
  • Fax: 973-209-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00237200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46TR000845000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00300300
License Number StateNJ

VIII. Authorized Official

Name: MRS. LINDA HARRIGAN
Title or Position: DIRECTOR OCCUPATIONAL THERAPIST
Credential: MA OTR L
Phone: 973-209-4064