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General NPI Number Information
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NPI Number | 1881235497
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Entity Type | Organization
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Legal Business Name | CBT AND PSYCHODYNAMIC THERAPY ASSOCIATES LLC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/04/2019
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Provider Practice Location Address
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Address Line | 245 WALNUT STREET
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City | ENGLEWOOD
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State | NJ
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Zip | 07631
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Country | US
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Telephone | 201-321-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 245 WALNUT STREET
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City | ENGLEWOOD
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State | NJ
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Zip | 07631
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Country | US
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Telephone | 201-321-4334
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER (LICENSED IN
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Name | DR. MICHAEL E. PORTMAN
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Credential | MSW, DPHIL LCSW
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Telephone | 201-321-4334
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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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