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General NPI Number Information
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NPI Number | 1659437002
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Entity Type | Organization
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Legal Business Name | MOSAIC PSYCHOTHERAPY GROUP
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 45 BROADWAY STE 203
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City | DENVILLE
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State | NJ
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Zip | 07834-2741
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Country | US
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Telephone | 973-625-7577
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Fax | 908-879-4007
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Provider Business Mailing Address
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Address Line | 45 BROADWAY STE 203
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City | DENVILLE
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State | NJ
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Zip | 07834-2741
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Country | US
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Telephone | 973-625-7577
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Fax | 908-879-4007
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE F PETRAT
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Credential | MSW
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Telephone | 973-625-7577
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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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