Provider Demographics
NPI:1124394531
Name:GENERATIONSOF CHANGE, LLC
Entity Type:Organization
Organization Name:GENERATIONSOF CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,, ACSW
Authorized Official - Phone:973-223-2172
Mailing Address - Street 1:13 MUNICIPAL PLZ
Mailing Address - Street 2:#2504
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-7200
Mailing Address - Country:US
Mailing Address - Phone:973-223-2172
Mailing Address - Fax:973-675-2251
Practice Address - Street 1:13 MUNICIPAL PLZ
Practice Address - Street 2:#2504
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-7200
Practice Address - Country:US
Practice Address - Phone:973-223-2172
Practice Address - Fax:973-675-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054635001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty