Provider Demographics
NPI:1437571742
Name:BERGEN PSYCHOTHERAPY PRACTICE
Entity Type:Organization
Organization Name:BERGEN PSYCHOTHERAPY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXCUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOON EUI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-240-8043
Mailing Address - Street 1:121 CEDAR LN
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4457
Mailing Address - Country:US
Mailing Address - Phone:201-240-8043
Mailing Address - Fax:201-648-2044
Practice Address - Street 1:121 CEDAR LANE
Practice Address - Street 2:SUITE 3D
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-240-8043
Practice Address - Fax:201-648-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00332400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health