Healthcare Provider Details

I. General information

NPI: 1205475589
Provider Name (Legal Business Name): HEAD AND HEART THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CEDAR LN STE 2B
TEANECK NJ
07666-4457
US

IV. Provider business mailing address

130 GOLF CT
TEANECK NJ
07666-5634
US

V. Phone/Fax

Practice location:
  • Phone: 201-357-5796
  • Fax:
Mailing address:
  • Phone: 610-937-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TAMI-BETH DANZIG
Title or Position: OWNER
Credential: LCSW
Phone: 610-937-4422