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General NPI Number Information
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NPI Number | 1790284909
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Entity Type | Organization
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Legal Business Name | THERACORP, LLC
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Dates
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Enumeration Date | 02/03/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 86 BRUNSWICK WOODS DR
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-5601
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Country | US
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Telephone | 973-207-6834
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ROXY CT
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City | FARMINGDALE
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State | NJ
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Zip | 07727-4203
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Country | US
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Telephone | 973-207-6834
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CHIEF OPERATING OFFICER
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Name | ALLA KRUTYANSKY
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Credential | MSW, LSW
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Telephone | 973-207-6834
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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 | NJ
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