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General NPI Number Information
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NPI Number | 1194273284
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY MILESTONES LLC
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Dates
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Enumeration Date | 09/16/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 470 RIDGEDALE AVE STE 3
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City | EAST HANOVER
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State | NJ
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Zip | 07936-3074
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Country | US
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Telephone | 973-515-1216
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Fax |
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Provider Business Mailing Address
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Address Line | 470 RIDGEDALE AVE STE 3
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City | EAST HANOVER
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State | NJ
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Zip | 07936-3074
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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
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Name | MRS. REBECCA LOGUNOVSKIY
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Credential | LPC, LMHC
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Telephone | 718-801-5843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00522600
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License Number State | NJ
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