Healthcare Provider Details

I. General information

NPI: 1467246348
Provider Name (Legal Business Name): RAISING WARRIORS PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 GRIFFITH ST APT A
JERSEY CITY NJ
07307-3609
US

IV. Provider business mailing address

233 GRIFFITH ST APT A
JERSEY CITY NJ
07307-3609
US

V. Phone/Fax

Practice location:
  • Phone: 908-752-3633
  • Fax:
Mailing address:
  • Phone: 908-752-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISA LOCASCIO
Title or Position: FOUNDER/OWNER
Credential: BCBA
Phone: 908-752-3633