Provider Demographics
NPI:1407078876
Name:ATLANTIC THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:ATLANTIC THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:KELLER
Authorized Official - Last Name:RODRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-223-3131
Mailing Address - Street 1:1913 ATLANTIC AVE
Mailing Address - Street 2:SUITE F5
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1029
Mailing Address - Country:US
Mailing Address - Phone:732-223-3131
Mailing Address - Fax:732-223-6262
Practice Address - Street 1:1913 ATLANTIC AVE
Practice Address - Street 2:SUITE F5
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1029
Practice Address - Country:US
Practice Address - Phone:732-223-3131
Practice Address - Fax:732-223-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051797001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty