Provider Demographics
NPI:1508453788
Name:INDIVIDUAL AND FAMILY THERAPEUTIC WELLNESS
Entity Type:Organization
Organization Name:INDIVIDUAL AND FAMILY THERAPEUTIC WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-992-9966
Mailing Address - Street 1:802 TILTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1233
Mailing Address - Country:US
Mailing Address - Phone:609-377-8074
Mailing Address - Fax:509-710-0400
Practice Address - Street 1:802 TILTON RD STE 102
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1233
Practice Address - Country:US
Practice Address - Phone:609-377-8074
Practice Address - Fax:509-710-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty