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General NPI Number Information
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NPI Number | 1861881302
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Entity Type | Organization
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Legal Business Name | HOPE THERAPEUTIC SERVICES, LLC.
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 460 BLOOMFIELD AVE SUITE 209
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3582
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Country | US
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Telephone | 973-563-8507
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Fax |
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Provider Business Mailing Address
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Address Line | 460 BLOOMFIELD AVE SUITE 209
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3582
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Country | US
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Telephone | 973-563-8507
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | FELICIA FDYFIL
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Credential | L.C.S.W.
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Telephone | 973-563-8507
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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 | 44SC05596900
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License Number State | NJ
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