Provider Demographics
NPI:1205217809
Name:REVIVE & THRIVE THERAPY LLC
Entity Type:Organization
Organization Name:REVIVE & THRIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:VIEIRA
Authorized Official - Last Name:ANJOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-315-5947
Mailing Address - Street 1:173 E GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2026
Mailing Address - Country:US
Mailing Address - Phone:908-315-5947
Mailing Address - Fax:908-344-5537
Practice Address - Street 1:173 E GRANT AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2026
Practice Address - Country:US
Practice Address - Phone:908-315-5947
Practice Address - Fax:908-344-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054859001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty