Provider Demographics
NPI:1386491355
Name:REVEAL TO HEAL CONSULTING A NJ NON PROFIT
Entity type:Organization
Organization Name:REVEAL TO HEAL CONSULTING A NJ NON PROFIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRETOR
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-371-4463
Mailing Address - Street 1:64 LENOX STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106
Mailing Address - Country:US
Mailing Address - Phone:862-371-4463
Mailing Address - Fax:
Practice Address - Street 1:2115 MILLBURN AVE LOWR LEVEL2
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3724
Practice Address - Country:US
Practice Address - Phone:863-371-4463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health