Healthcare Provider Details

I. General information

NPI: 1487075933
Provider Name (Legal Business Name): RHONDA LISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2014
Last Update Date: 01/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ARCADIAN WAY SUITE C2
PARAMUS NJ
07652-1291
US

IV. Provider business mailing address

16 ARCADIAN WAY SUITE C2
PARAMUS NJ
07652-1291
US

V. Phone/Fax

Practice location:
  • Phone: 201-845-9800
  • Fax:
Mailing address:
  • Phone: 201-845-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SC05221000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: