Provider Demographics
NPI:1598272049
Name:PODELL THERAPY GROUP
Entity Type:Organization
Organization Name:PODELL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PODELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-368-2626
Mailing Address - Street 1:140 N RTE 17 STE 250
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2821
Mailing Address - Country:US
Mailing Address - Phone:201-368-2626
Mailing Address - Fax:
Practice Address - Street 1:140 N RTE 17 STE 250
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2821
Practice Address - Country:US
Practice Address - Phone:201-368-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC043161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty