Provider Demographics
NPI:1003386624
Name:REBUILD THERAPY AND TREATMENT SERVICES
Entity Type:Organization
Organization Name:REBUILD THERAPY AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-861-9780
Mailing Address - Street 1:26 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1019
Practice Address - Country:US
Practice Address - Phone:732-861-9780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty