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General NPI Number Information
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NPI Number | 1417021064
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Entity Type | Organization
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Legal Business Name | STARFISH EXPERIENCE NC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 192 3RD AVE
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City | WESTWOOD
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State | NJ
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Zip | 07675-2154
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Country | US
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Telephone | 201-594-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 58 HICKORY HILL LN
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City | TAPPAN
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State | NY
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Zip | 10983-1825
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Country | US
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Telephone | 845-359-1539
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHEILA KAMINSKI
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Credential | LCSW
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Telephone | 201-594-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC04387700
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License Number State | NJ
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