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General NPI Number Information
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NPI Number | 1821438664
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Entity Type | Organization
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Legal Business Name | GROUP THERAPY CENTRAL LLC
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 362 MIDLAND AVE 2ND FLOOR
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City | GARFIELD
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State | NJ
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Zip | 07026-1736
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Country | US
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Telephone | 973-513-3187
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Fax |
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Provider Business Mailing Address
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Address Line | 340 AYCRIGG AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-3714
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Country | US
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Telephone | 973-513-3187
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. ALEXANDER HERZOG
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Credential | LCSW
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Telephone | 973-513-3187
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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 | 44SC05425000
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License Number State | NJ
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