Provider Demographics
NPI:1235893660
Name:AQUARIUS RISING, LLC
Entity Type:Organization
Organization Name:AQUARIUS RISING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:PATRIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-553-5076
Mailing Address - Street 1:230 COUNTISS AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2509
Mailing Address - Country:US
Mailing Address - Phone:856-889-5243
Mailing Address - Fax:
Practice Address - Street 1:230 COUNTISS AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-2509
Practice Address - Country:US
Practice Address - Phone:856-553-5076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health