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General NPI Number Information
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NPI Number | 1508142498
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Entity Type | Organization
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Legal Business Name | BALANCE AND THRIVE, LLC
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 61 N MAPLE AVE (202)
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-444-8110
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Fax |
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Provider Business Mailing Address
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Address Line | 61 N MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-444-8110
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ROSE CELIA ROSATO
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Credential | MA, LPC
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Telephone | 201-612-2355
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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 | 44SC05477700
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License Number State | NJ
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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 | 44SC05422300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC0067100
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License Number State | NJ
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