Provider Demographics
NPI:1386108488
Name:ON YOUR MARK TEEN COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:ON YOUR MARK TEEN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPASSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-885-3712
Mailing Address - Street 1:PO BOX 43701
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-0701
Mailing Address - Country:US
Mailing Address - Phone:973-746-2500
Mailing Address - Fax:973-746-2502
Practice Address - Street 1:605 VALLEY RD STE 4
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1455
Practice Address - Country:US
Practice Address - Phone:973-746-2500
Practice Address - Fax:973-746-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1861737421OtherNPI