Healthcare Provider Details

I. General information

NPI: 1558741710
Provider Name (Legal Business Name): AFFILIATED PSYCHOTHERAPISTS - A CENTER FOR CHANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 HILL RD
PARSIPPANY NJ
07054-1078
US

IV. Provider business mailing address

26 HILL RD
PARSIPPANY NJ
07054-1001
US

V. Phone/Fax

Practice location:
  • Phone: 973-335-9909
  • Fax:
Mailing address:
  • Phone: 973-335-9909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KATELYN LEE
Title or Position: EXECUTIVE DIRECTOR OF OPERATIONS
Credential:
Phone: 973-335-9909