Healthcare Provider Details

I. General information

NPI: 1356930267
Provider Name (Legal Business Name): THE WHOLE FAMILY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 10/04/2024
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WESTWOOD AVE
RIVER VALE NJ
07675-6295
US

IV. Provider business mailing address

101 PALISADE AVE
WESTWOOD NJ
07675-2529
US

V. Phone/Fax

Practice location:
  • Phone: 201-232-9632
  • Fax:
Mailing address:
  • Phone: 201-232-9632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: STACIE GOLDFLAM
Title or Position: PRESIDENT
Credential: LCSW
Phone: 201-232-9828