Provider Demographics
NPI:1124601299
Name:LITTLE MOON LLC
Entity Type:Organization
Organization Name:LITTLE MOON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:SKOW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:848-248-7282
Mailing Address - Street 1:200 WHITE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1162
Mailing Address - Country:US
Mailing Address - Phone:848-248-7282
Mailing Address - Fax:732-842-1794
Practice Address - Street 1:200 WHITE RD STE 208
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1162
Practice Address - Country:US
Practice Address - Phone:848-248-7282
Practice Address - Fax:732-842-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health