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General NPI Number Information
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NPI Number | 1124601299
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Entity Type | Organization
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Legal Business Name | LITTLE MOON LLC
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 200 WHITE RD STE 208
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1162
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Country | US
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Telephone | 848-248-7282
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Fax | 732-842-1794
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Provider Business Mailing Address
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Address Line | 200 WHITE RD STE 208
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1162
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Country | US
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Telephone | 848-248-7282
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Fax | 732-842-1794
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | FARAH N SKOW
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Credential | LPC
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Telephone | 848-248-7282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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