Provider Demographics
NPI:1497460430
Name:SEASONS OF LIFE THERAPY, LLC
Entity Type:Organization
Organization Name:SEASONS OF LIFE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-681-4686
Mailing Address - Street 1:501 ROUTE 17 SOUTH STE 1
Mailing Address - Street 2:#1091
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:201-681-4686
Mailing Address - Fax:
Practice Address - Street 1:5 OAKWOOD ROAD
Practice Address - Street 2:#1091
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401
Practice Address - Country:US
Practice Address - Phone:201-681-4686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1780396432OtherNPI OF PROVIDER