=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205331865
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW PERSPECTIVES NJ LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2018
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55A E RIDGEWOOD AVE STE 6
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-3884
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-669-4911
-----------------------------------------------------
Fax | 201-540-8104
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55A E RIDGEWOOD AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07450-3867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-669-4911
-----------------------------------------------------
Fax | 201-540-8104
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | CHRISTINA ATHANASATOS
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 201-669-4911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05335900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------