Provider Demographics
NPI:1790284909
Name:THERACORP, LLC
Entity Type:Organization
Organization Name:THERACORP, LLC
Other - Org Name:THERACORP THERAPEUTIC SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUTYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:973-207-6834
Mailing Address - Street 1:5 ROXY CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-4203
Mailing Address - Country:US
Mailing Address - Phone:973-207-6834
Mailing Address - Fax:
Practice Address - Street 1:86 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:973-207-6834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty