Provider Demographics
NPI:1508074774
Name:CHANGES A PSYCHOTHERAPEUTIC PRACTICE
Entity Type:Organization
Organization Name:CHANGES A PSYCHOTHERAPEUTIC PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-653-0665
Mailing Address - Street 1:411 W EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1709
Mailing Address - Country:US
Mailing Address - Phone:609-653-0665
Mailing Address - Fax:609-926-8697
Practice Address - Street 1:505 HAMILTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1057
Practice Address - Country:US
Practice Address - Phone:609-653-0665
Practice Address - Fax:609-926-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014533001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7704433OtherAETNA
NJ7704433OtherAETNA