Provider Demographics
NPI:1629213350
Name:THERAPEUTIC ACCESS LLC
Entity Type:Organization
Organization Name:THERAPEUTIC ACCESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:MOSIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-699-0279
Mailing Address - Street 1:75 ESSEX ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4036
Mailing Address - Country:US
Mailing Address - Phone:973-699-0279
Mailing Address - Fax:
Practice Address - Street 1:75 ESSEX ST
Practice Address - Street 2:SUITE 206
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4036
Practice Address - Country:US
Practice Address - Phone:973-699-0279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05320500251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health