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General NPI Number Information
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NPI Number | 1811602014
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE WELLNESS & THERAPY GROUP OF NEW JERSEY LLC
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 350 W PASSAIC ST
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3073
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Country | US
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Telephone | 201-822-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MIDLAND AVE UNIT 131
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City | KEARNY
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State | NJ
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Zip | 07032-6806
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | THABATHA BORER
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Credential |
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Telephone | 201-822-1232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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