Healthcare Provider Details

I. General information

NPI: 1215523469
Provider Name (Legal Business Name): LOGICAL RELATIONS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/11/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 GLENRIDGE AVE UNIT 381
MONTCLAIR NJ
07042-6816
US

IV. Provider business mailing address

125 GLENRIDGE AVE UNIT 381
MONTCLAIR NJ
07042-6816
US

V. Phone/Fax

Practice location:
  • Phone: 973-963-4136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEFANIE SANTIAGO
Title or Position: CO-OWNER
Credential: LMFT, LCADC
Phone: 973-963-4136