Provider Demographics
NPI:1508288465
Name:SELF EMPOWERING JOURNEYS, LLC
Entity Type:Organization
Organization Name:SELF EMPOWERING JOURNEYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MPS,LMFT
Authorized Official - Phone:201-428-7733
Mailing Address - Street 1:9 GUNTHERS VW
Mailing Address - Street 2:
Mailing Address - City:TOWACO
Mailing Address - State:NJ
Mailing Address - Zip Code:07082-1359
Mailing Address - Country:US
Mailing Address - Phone:201-428-7733
Mailing Address - Fax:
Practice Address - Street 1:330 CHANGEBRIDGE RD
Practice Address - Street 2:MONTVILLE EXECUTIVE SUITES
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058-9839
Practice Address - Country:US
Practice Address - Phone:201-428-7733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100166600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty