Provider Demographics
NPI:1164839064
Name:DB THERAPY ASSOCIATES LLC
Entity Type:Organization
Organization Name:DB THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-970-5793
Mailing Address - Street 1:7 RANDOLPH TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3316
Mailing Address - Country:US
Mailing Address - Phone:201-970-5793
Mailing Address - Fax:
Practice Address - Street 1:31 TRINITY PL
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2773
Practice Address - Country:US
Practice Address - Phone:201-577-8470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00363100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ12266865OtherCAQH
NJ4200088OtherCIGNA
NJ600715191OtherMAGELLAN BEHAVIORAL HEALTH