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General NPI Number Information
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NPI Number | 1013568575
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Entity Type | Organization
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Legal Business Name | EMERGE- THE COUNSELING AND COACHING CENTER
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 162 E RIDGEWOOD AVE STE 2
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3846
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Country | US
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Telephone | 517-750-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 42 2ND AVE
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City | HAWTHORNE
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State | NJ
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Zip | 07506-2408
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR/ THERAPIST
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Name | TANVI MATHEW
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Credential | LPC
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Telephone | 201-953-0819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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