Healthcare Provider Details

I. General information

NPI: 1316789688
Provider Name (Legal Business Name): JR TALK THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 PROSPECT ST
MIDLAND PARK NJ
07432-1125
US

IV. Provider business mailing address

417 PROSPECT ST
MIDLAND PARK NJ
07432-1125
US

V. Phone/Fax

Practice location:
  • Phone: 347-409-6688
  • Fax:
Mailing address:
  • Phone: 347-409-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIA ROZIN
Title or Position: CLINICAL PSYCHOTHERAPIST
Credential: LMHC, LPC
Phone: 212-287-5026