Healthcare Provider Details

I. General information

NPI: 1811239858
Provider Name (Legal Business Name): ARC-EN-CIEL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 WATCHUNG PLZ SUITE 512
MONTCLAIR NJ
07042-4117
US

IV. Provider business mailing address

41 WATCHUNG PLZ SUITE 512
MONTCLAIR NJ
07042-4117
US

V. Phone/Fax

Practice location:
  • Phone: 888-543-7726
  • Fax: 888-810-1298
Mailing address:
  • Phone: 888-543-7726
  • Fax: 888-810-1298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number235Z00000X.
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1743089
License Number StateNJ

VIII. Authorized Official

Name: MS. THERESA MANAP
Title or Position: PRESIDENT
Credential:
Phone: 888-543-7726