Provider Demographics
NPI:1144391269
Name:MOVING ON LFE CENTER
Entity Type:Organization
Organization Name:MOVING ON LFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-837-8590
Mailing Address - Street 1:121 CEDAR LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4457
Mailing Address - Country:US
Mailing Address - Phone:201-837-8590
Mailing Address - Fax:201-837-8593
Practice Address - Street 1:121 CEDAR LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-6116
Practice Address - Country:US
Practice Address - Phone:201-837-8590
Practice Address - Fax:201-837-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00024900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty