Healthcare Provider Details

I. General information

NPI: 1033083688
Provider Name (Legal Business Name): BLUEBIRD THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AYERS CT APT 1C
TEANECK NJ
07666-5127
US

IV. Provider business mailing address

126 AYERS CT APT 1C
TEANECK NJ
07666-5127
US

V. Phone/Fax

Practice location:
  • Phone: 910-777-7229
  • Fax:
Mailing address:
  • Phone: 910-777-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. YONI SOKEL
Title or Position: PRESIDENT
Credential:
Phone: 910-777-7229