Provider Demographics
NPI:1003258799
Name:NEW JERSEY ASSOCIATION FOR PSYCHOTHERAPY
Entity Type:Organization
Organization Name:NEW JERSEY ASSOCIATION FOR PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WELSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LMFT
Authorized Official - Phone:973-763-2222
Mailing Address - Street 1:2115 MILLBURN AVENUE
Mailing Address - Street 2:SUITE 100-4
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040
Mailing Address - Country:US
Mailing Address - Phone:973-763-2222
Mailing Address - Fax:973-324-9705
Practice Address - Street 1:2115 MILLBURN AVENUE
Practice Address - Street 2:SUITE 100-4
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040
Practice Address - Country:US
Practice Address - Phone:973-763-2222
Practice Address - Fax:973-324-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ8811765781041C0700X
NJ37F100085600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty