Healthcare Provider Details

I. General information

NPI: 1154787281
Provider Name (Legal Business Name): STORY OF LIFE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 CUMBERLAND AVE
TEANECK NJ
07666-2651
US

IV. Provider business mailing address

572 CUMBERLAND AVE
TEANECK NJ
07666-2651
US

V. Phone/Fax

Practice location:
  • Phone: 201-578-7831
  • Fax:
Mailing address:
  • Phone: 201-578-7831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DALIA LIGHTMAN
Title or Position: PSYCHOLOGIST
Credential: PSYD
Phone: 201-578-7831