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General NPI Number Information
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NPI Number | 1902310196
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Entity Type | Organization
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Legal Business Name | WINTERTREE PSYCHOTHERAPY
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 129 VALLEY RD
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2331
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Country | US
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Telephone | 973-650-1832
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Fax |
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Provider Business Mailing Address
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Address Line | 31 COBBLESTONE TER
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City | MONTVILLE
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State | NJ
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Zip | 07045-9490
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Country | US
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Telephone | 973-650-1832
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAREN LEE BENENSON
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Credential | MSW, LCSW
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Telephone | 973-650-1832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 44SC
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 44SC05749600
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License Number State | NJ
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