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General NPI Number Information
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NPI Number | 1396152781
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Entity Type | Organization
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Legal Business Name | NORTHERN NEW JERSEY COUNSELING CENTER LLC
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 39 EAST MAIN STREET, 2ND FLOOR
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-2206
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Country | US
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Telephone | 973-454-5569
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Fax | 973-454-5569
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Provider Business Mailing Address
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Address Line | 39 EAST MAIN STREET, 2ND FLOOR
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-2206
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Country | US
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Telephone | 973-454-5569
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Fax | 973-454-5569
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Authorized Official
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Title or Position | PROPRIETOR
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Name | ANASTASIA RAISA PYTAL
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Credential | PSYD
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Telephone | 973-454-5569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35S100528800
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License Number State | NJ
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