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General NPI Number Information
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NPI Number | 1588579775
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Entity Type | Organization
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Legal Business Name | OUR SPACE NORTHEAST
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 88 W RIDGEWOOD AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3199
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Country | US
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Telephone | 201-714-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 130 W PLEASANT AVE STE 85
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City | MAYWOOD
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State | NJ
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Zip | 07607-1335
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Country | US
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Telephone | 201-714-0820
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Fax |
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | DR. JACQUELINE COLLARD
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Credential | DSW, LCSW
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Telephone | 908-721-6728
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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 |
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License Number State |
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