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General NPI Number Information
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NPI Number | 1790257111
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Entity Type | Organization
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Legal Business Name | LIVING IN THE SECOND HALF L. L. C
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Dates
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Enumeration Date | 12/24/2018
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Last Update Date | 12/24/2018
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Provider Practice Location Address
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Address Line | 33 PLYMOUTH ST STE 301
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2677
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Country | US
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Telephone | 646-859-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 33 PLYMOUTH ST STE 301
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2677
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Country | US
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Telephone | 646-859-0125
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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. VANESSA ANGELA WATSON
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Credential | LCSW
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Telephone | 646-859-0125
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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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