Healthcare Provider Details

I. General information

NPI: 1508142498
Provider Name (Legal Business Name): BALANCE AND THRIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 N MAPLE AVE (202)
RIDGEWOOD NJ
07450-3255
US

IV. Provider business mailing address

61 N MAPLE AVE
RIDGEWOOD NJ
07450-3255
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-8110
  • Fax:
Mailing address:
  • Phone: 201-444-8110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC0067100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05477700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05422300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. ROSE CELIA ROSATO
Title or Position: OWNER
Credential: MA, LPC
Phone: 201-612-2355