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General NPI Number Information
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NPI Number | 1407078876
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Entity Type | Organization
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Legal Business Name | ATLANTIC THERAPY ASSOCIATES
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1913 ATLANTIC AVE SUITE F5
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City | MANASQUAN
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State | NJ
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Zip | 08736-1029
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Country | US
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Telephone | 732-223-3131
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Fax | 732-223-6262
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Provider Business Mailing Address
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Address Line | 1913 ATLANTIC AVE SUITE F5
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City | MANASQUAN
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State | NJ
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Zip | 08736-1029
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Country | US
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Telephone | 732-223-3131
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Fax | 732-223-6262
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HEIDI KELLER RODRICK
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Credential | L.C.S.W.
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Telephone | 732-223-3131
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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 | 44SC05179700
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License Number State | NJ
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