Provider Demographics
NPI:1750644274
Name:NJ FAMILY THERAPY
Entity Type:Organization
Organization Name:NJ FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGDALENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GESIARZ-OCCHICONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:845-642-6697
Mailing Address - Street 1:48 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1509
Mailing Address - Country:US
Mailing Address - Phone:845-642-6697
Mailing Address - Fax:
Practice Address - Street 1:48 ELM ST
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1509
Practice Address - Country:US
Practice Address - Phone:845-642-6697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI001671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty