Provider Demographics
NPI:1396152781
Name:NORTHERN NEW JERSEY COUNSELING CENTER LLC
Entity type:Organization
Organization Name:NORTHERN NEW JERSEY COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:RAISA
Authorized Official - Last Name:PYTAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:973-454-5569
Mailing Address - Street 1:39 EAST MAIN STREET, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2206
Mailing Address - Country:US
Mailing Address - Phone:973-454-5569
Mailing Address - Fax:973-454-5569
Practice Address - Street 1:39 EAST MAIN STREET, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-2206
Practice Address - Country:US
Practice Address - Phone:973-454-5569
Practice Address - Fax:973-454-5569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100528800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty