=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528436532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ATTACHMENT ALLIANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2015
-----------------------------------------------------
Last Update Date | 09/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94 PARK ST SUITE 1
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-6680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94 PARK ST SUITE 1
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07042-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-534-6680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | BRIDGET M DEVINE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 973-534-6680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05646100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------