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General NPI Number Information
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NPI Number | 1639735194
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Entity Type | Organization
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Legal Business Name | BUILDING SUCCESSFUL RELATIONSHIPS, LLC
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Dates
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Enumeration Date | 05/10/2019
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Last Update Date | 05/10/2019
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Provider Practice Location Address
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Address Line | 311 CLAREMONT AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2240
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Country | US
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Telephone | 201-694-2932
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 621
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City | HAWTHORNE
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State | NJ
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Zip | 07507-0621
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Country | US
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Telephone | 201-694-2932
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. SCOTT ROBERT MALLON
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Credential | LMFT
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Telephone | 201-694-2932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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