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General NPI Number Information
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NPI Number | 1154715449
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Entity Type | Organization
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Legal Business Name | TWIN RIVERS PSYCHOTHERAPY ASSOCIATES
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 39 AVENUE AT THE CMN SUITE 106
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4807
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Country | US
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Telephone | 732-788-7835
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Fax | 732-865-7190
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Provider Business Mailing Address
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Address Line | 43 MONROE AVE
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4017
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Country | US
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Telephone | 732-788-7835
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Fax | 732-865-7190
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Authorized Official
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Title or Position | OWNER
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Name | JASON O'DONNELL
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Credential | LCSW
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Telephone | 732-788-7835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05541800
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License Number State | NJ
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