Provider Demographics
NPI:1467979336
Name:OVITZ PSYCHOTHERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:OVITZ PSYCHOTHERAPY ASSOCIATES, LLC
Other - Org Name:OVITZ PSYCHOTHERAPY ASSOCIATES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-609-7056
Mailing Address - Street 1:PO BOX 4607
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-4607
Mailing Address - Country:US
Mailing Address - Phone:917-609-7056
Mailing Address - Fax:
Practice Address - Street 1:2001 LINCOLN DR W STE A
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1531
Practice Address - Country:US
Practice Address - Phone:917-609-7056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04644000261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health