Provider Demographics
NPI:1275174955
Name:S.E.L.F THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:S.E.L.F THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENGLIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAJUSTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-619-0392
Mailing Address - Street 1:12 LANDVALE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884-1713
Mailing Address - Country:US
Mailing Address - Phone:732-619-0392
Mailing Address - Fax:
Practice Address - Street 1:727 FRANKLIN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3624
Practice Address - Country:US
Practice Address - Phone:732-619-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty