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General NPI Number Information
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NPI Number | 1467979336
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Entity Type | Organization
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Legal Business Name | OVITZ PSYCHOTHERAPY ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 08/23/2017
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Provider Practice Location Address
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Address Line | 2001 LINCOLN DR W STE A
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City | MARLTON
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State | NJ
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Zip | 08053-1531
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Country | US
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Telephone | 917-609-7056
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4607
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City | CHERRY HILL
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State | NJ
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Zip | 08034-4607
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Country | US
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Telephone | 917-609-7056
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | KENNETH DAVID OVITZ
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Credential | LCSW
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Telephone | 917-609-7056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 44SC04644000
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License Number State | NJ
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