Provider Demographics
NPI:1730303884
Name:RESTORE MIND AND BODY LLC
Entity Type:Organization
Organization Name:RESTORE MIND AND BODY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARITE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC RYT
Authorized Official - Phone:973-601-7788
Mailing Address - Street 1:7 LAKESIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-1309
Mailing Address - Country:US
Mailing Address - Phone:973-601-7788
Mailing Address - Fax:
Practice Address - Street 1:230 US HIGHWAY 206
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9189
Practice Address - Country:US
Practice Address - Phone:973-601-7788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00145100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty