Provider Demographics
NPI:1104294024
Name:CLINICAL PSYCHOTHERAPY & CONSULTATION, LLC
Entity type:Organization
Organization Name:CLINICAL PSYCHOTHERAPY & CONSULTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:BLOODGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:908-454-4070
Mailing Address - Street 1:600 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1971
Mailing Address - Country:US
Mailing Address - Phone:908-454-4070
Mailing Address - Fax:908-454-4071
Practice Address - Street 1:600 COVENTRY DR
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1971
Practice Address - Country:US
Practice Address - Phone:908-454-4070
Practice Address - Fax:908-454-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100512900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ678312OtherVALUE OPTIONS