Healthcare Provider Details

I. General information

NPI: 1245134519
Provider Name (Legal Business Name): REVIVAL THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 1ST ST
NORTHFIELD NJ
08225-2035
US

IV. Provider business mailing address

709 1ST ST
NORTHFIELD NJ
08225-2035
US

V. Phone/Fax

Practice location:
  • Phone: 609-464-3606
  • Fax:
Mailing address:
  • Phone: 609-464-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARGARET LINN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 609-464-3606