=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093448334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THOUGHTFUL MIND WITH TZVI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2022
-----------------------------------------------------
Last Update Date | 07/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 WHITE RD STE 208
-----------------------------------------------------
City | LITTLE SILVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07739-1162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-945-6771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 FINCHLEY BLVD
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-525-8913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TZVI ZEV HILSENRATH
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 848-525-8913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------