Provider Demographics
NPI:1073292124
Name:MOONBOW COUNSELING LLC
Entity Type:Organization
Organization Name:MOONBOW COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLIVKA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-468-9915
Mailing Address - Street 1:123 LEGION PL
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 LEGION PL
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-1537
Practice Address - Country:US
Practice Address - Phone:201-468-9915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty