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General NPI Number Information
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NPI Number | 1508359829
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Entity Type | Organization
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Legal Business Name | FAMILY DYNAMICS LLC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 216 DAYTON ST STE 3
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4450
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Country | US
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Telephone | 201-978-7585
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Fax |
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Provider Business Mailing Address
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Address Line | 210 GAYNOR PL
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City | GLEN ROCK
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State | NJ
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Zip | 07452-3644
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Country | US
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Telephone | 201-873-7907
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. KRISTEN KURTH
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Credential | LPC
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Telephone | 201-873-7907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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