Provider Demographics
NPI:1821438664
Name:GROUP THERAPY CENTRAL LLC
Entity Type:Organization
Organization Name:GROUP THERAPY CENTRAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-513-3187
Mailing Address - Street 1:340 AYCRIGG AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3714
Mailing Address - Country:US
Mailing Address - Phone:973-513-3187
Mailing Address - Fax:
Practice Address - Street 1:362 MIDLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1736
Practice Address - Country:US
Practice Address - Phone:973-513-3187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054250001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty