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General NPI Number Information
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NPI Number | 1104294446
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH THERAPY GROUP
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Dates
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Enumeration Date | 09/03/2015
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 63 MILLTOWN RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2378
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Country | US
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Telephone | 732-659-0683
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Fax |
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Provider Business Mailing Address
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Address Line | 63 MILLTOWN RD
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-2378
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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 | OWNER/ FOUNDER
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Name | GUL NOREEN IQBAL
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Credential | LCSW
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Telephone | 732-890-1875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 44SL05679900
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License Number State | NJ
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