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General NPI Number Information
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NPI Number | 1518434620
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Entity Type | Organization
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Legal Business Name | ICDL
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 09/01/2019
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Provider Practice Location Address
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Address Line | 999 RIVERVIEW DR STE 201
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City | TOTOWA
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State | NJ
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Zip | 07512-1165
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Country | US
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Telephone | 973-797-9680
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Fax |
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Provider Business Mailing Address
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Address Line | 999 RIVERVIEW DR STE 201
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City | TOTOWA
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State | NJ
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Zip | 07512-1165
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Country | US
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Telephone | 973-797-9680
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY GUENZEL
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Credential |
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Telephone | 973-797-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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