Provider Demographics
NPI:1154715449
Name:TWIN RIVERS PSYCHOTHERAPY ASSOCIATES
Entity type:Organization
Organization Name:TWIN RIVERS PSYCHOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-788-7835
Mailing Address - Street 1:43 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4017
Mailing Address - Country:US
Mailing Address - Phone:732-788-7835
Mailing Address - Fax:732-865-7190
Practice Address - Street 1:39 AVENUE AT THE CMN
Practice Address - Street 2:SUITE 106
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4807
Practice Address - Country:US
Practice Address - Phone:732-788-7835
Practice Address - Fax:732-865-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055418001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033557137OtherNPI
1033557137OtherNPI