Provider Demographics
NPI:1619689692
Name:THE BOUNDARY NYC LLC
Entity Type:Organization
Organization Name:THE BOUNDARY NYC LLC
Other - Org Name:THE BOUNDARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGALE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-543-1507
Mailing Address - Street 1:300 MAIN ST.
Mailing Address - Street 2:#1010 STE 65
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:646-543-1507
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST STE 65
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2369
Practice Address - Country:US
Practice Address - Phone:646-543-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-21
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty