Healthcare Provider Details

I. General information

NPI: 1407592496
Provider Name (Legal Business Name): NEW BRUNSWICK THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 GEORGE ST STE 191
NEW BRUNSWICK NJ
08901-2036
US

IV. Provider business mailing address

335 GEORGE ST STE 191
NEW BRUNSWICK NJ
08901-2036
US

V. Phone/Fax

Practice location:
  • Phone: 732-640-8501
  • Fax:
Mailing address:
  • Phone: 732-640-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KAYE RAMIREZ
Title or Position: OWNER
Credential: PSYD
Phone: 732-640-8501