Provider Demographics
NPI:1114514858
Name:DEPKO COGNITIVE THERAPY
Entity type:Organization
Organization Name:DEPKO COGNITIVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPKO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-902-9861
Mailing Address - Street 1:2164 HWY 35
Mailing Address - Street 2:BLDG C, SUITE 8
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750
Mailing Address - Country:US
Mailing Address - Phone:908-902-9861
Mailing Address - Fax:
Practice Address - Street 1:2164 HWY 35
Practice Address - Street 2:BLDG C, SUITE 8
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750
Practice Address - Country:US
Practice Address - Phone:908-902-9861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health