Provider Demographics
NPI:1386290278
Name:RIVER THERAPEUTICS
Entity type:Organization
Organization Name:RIVER THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-575-7341
Mailing Address - Street 1:250 WASHINGTON ST STE A2
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7583
Mailing Address - Country:US
Mailing Address - Phone:732-575-7341
Mailing Address - Fax:
Practice Address - Street 1:250 WASHINGTON ST STE A2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7583
Practice Address - Country:US
Practice Address - Phone:732-575-7341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty