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General NPI Number Information
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NPI Number | 1124421144
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Entity Type | Organization
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Legal Business Name | PATHWAY PERSONAL COUNSELING
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Dates
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Enumeration Date | 10/04/2014
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Last Update Date | 10/04/2014
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Provider Practice Location Address
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Address Line | 560 SYLVAN AVE
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-3119
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Country | US
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Telephone | 201-567-6597
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Fax |
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Provider Business Mailing Address
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Address Line | 781 8TH ST
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City | SECAUCUS
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State | NJ
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Zip | 07094-3343
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Country | US
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Telephone | 201-981-5033
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARISA HAMILTON
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Credential | LCSW
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Telephone | 201-245-1166
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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 | 44SC05359300
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License Number State | NJ
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