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General NPI Number Information
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NPI Number | 1346778933
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Entity Type | Organization
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Legal Business Name | GREEN MEADOWS THERAPY CENTER
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 05/26/2017
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Provider Practice Location Address
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Address Line | 251 OAK GLEN RD
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City | HOWELL
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State | NJ
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Zip | 07731-8616
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Country | US
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Telephone | 732-272-0177
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Fax |
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Provider Business Mailing Address
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Address Line | 251 OAK GLEN RD
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City | HOWELL
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State | NJ
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Zip | 07731-8616
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Country | US
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Telephone | 732-503-6119
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | ARYEH PETGORSKY
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Credential |
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Telephone | 732-272-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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