Provider Demographics
NPI:1700390549
Name:SUPPORTIVE THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:SUPPORTIVE THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RAUSHANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:973-325-3132
Mailing Address - Street 1:59 MAIN ST STE 205A
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5333
Mailing Address - Country:US
Mailing Address - Phone:973-325-3132
Mailing Address - Fax:973-789-9625
Practice Address - Street 1:59 MAIN ST STE 205A
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5333
Practice Address - Country:US
Practice Address - Phone:973-325-3132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000745460OtherUNITED HEALTHCARE
NJ5582638OtherCIGNA
NJ900203OtherHBCBS
NJ5582638OtherCIGNA