Provider Demographics
NPI:1558736942
Name:TAILORED FOR CHANGE, LLC
Entity Type:Organization
Organization Name:TAILORED FOR CHANGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER; CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-518-1075
Mailing Address - Street 1:400 38TH STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:917-518-1075
Mailing Address - Fax:
Practice Address - Street 1:400 38TH STREET
Practice Address - Street 2:210
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:917-518-1075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05372001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty