Provider Demographics
NPI:1639634470
Name:PROGRESSIVE OPTION SUPPORT SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE OPTION SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL/MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-241-4140
Mailing Address - Street 1:221 RIVER STREET, 9TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030
Mailing Address - Country:US
Mailing Address - Phone:201-241-4041
Mailing Address - Fax:201-328-9424
Practice Address - Street 1:221 RIVER STREET 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-241-4140
Practice Address - Fax:201-328-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty