Provider Demographics
NPI:1275251084
Name:OUR CHILD THERAPY VA LLC
Entity Type:Organization
Organization Name:OUR CHILD THERAPY VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-226-4806
Mailing Address - Street 1:211 BLVD OF THE AMERICAS
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:917-974-9300
Mailing Address - Fax:
Practice Address - Street 1:5300 KEMPSRIVER DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5369
Practice Address - Country:US
Practice Address - Phone:917-974-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR CHILD THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-17
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty