Provider Demographics
NPI:1659045896
Name:ACM THERAPY LLC
Entity type:Organization
Organization Name:ACM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA-MINCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-421-8789
Mailing Address - Street 1:95 MARY ANN LN
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-3138
Mailing Address - Country:US
Mailing Address - Phone:201-421-8789
Mailing Address - Fax:
Practice Address - Street 1:362 MAIN ST
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-1928
Practice Address - Country:US
Practice Address - Phone:201-421-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health