Provider Demographics
NPI:1104440080
Name:FLORA MARTINS DEGEORGE
Entity type:Organization
Organization Name:FLORA MARTINS DEGEORGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:MARTINS
Authorized Official - Last Name:DEGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-535-4461
Mailing Address - Street 1:55 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5945
Mailing Address - Country:US
Mailing Address - Phone:917-535-4461
Mailing Address - Fax:
Practice Address - Street 1:CENTER FOR PSYCHOTHERAPY
Practice Address - Street 2:215 RIDGEDALE AV
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-0793
Practice Address - Country:US
Practice Address - Phone:917-535-4461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)