Provider Demographics
NPI:1316509573
Name:YOUR TIME FOR CHANGE
Entity type:Organization
Organization Name:YOUR TIME FOR CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIBOLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-600-0489
Mailing Address - Street 1:2557 HOLLY HILL RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-6201
Mailing Address - Country:US
Mailing Address - Phone:732-600-0489
Mailing Address - Fax:
Practice Address - Street 1:1035 HOOPER AVE STE 2A
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8355
Practice Address - Country:US
Practice Address - Phone:732-600-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty