Provider Demographics
NPI:1093463762
Name:PATH FORWARD THERAPY LLC
Entity Type:Organization
Organization Name:PATH FORWARD THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:W
Authorized Official - Last Name:THEWES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-316-6696
Mailing Address - Street 1:125 BROEMEL PL UNIT 65
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-8001
Mailing Address - Country:US
Mailing Address - Phone:609-933-5577
Mailing Address - Fax:
Practice Address - Street 1:32 NASSAU ST STE 400
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4503
Practice Address - Country:US
Practice Address - Phone:609-316-6696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty