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General NPI Number Information
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NPI Number | 1548633365
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Entity Type | Organization
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Legal Business Name | NICHOLAS BIZZARRO PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/02/2015
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 90 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-2144
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Country | US
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Telephone | 908-610-7587
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Fax |
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Provider Business Mailing Address
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Address Line | 110 FAIRVIEW AVE STE 2
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City | VERONA
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State | NJ
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Zip | 07044-1318
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Country | US
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Telephone | 908-610-7587
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. NICHOLAS A BIZZARRO
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Credential |
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Telephone | 908-610-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 44SC05622300
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License Number State | NJ
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