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General NPI Number Information
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NPI Number | 1750644274
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Entity Type | Organization
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Legal Business Name | NJ FAMILY THERAPY
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 48 ELM ST
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City | ALLENDALE
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State | NJ
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Zip | 07401-1509
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Country | US
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Telephone | 845-642-6697
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Fax |
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Provider Business Mailing Address
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Address Line | 48 ELM ST
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City | ALLENDALE
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State | NJ
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Zip | 07401-1509
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Country | US
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Telephone | 845-642-6697
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MAGDALENA GESIARZ-OCCHICONE
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Credential | LMFT
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Telephone | 845-642-6697
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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 | 37FI001671
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License Number State | NJ
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