Provider Demographics
NPI:1851045207
Name:PHOENIX PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:PHOENIX PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:732-786-4804
Mailing Address - Street 1:191 US 9 S
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8233
Mailing Address - Country:US
Mailing Address - Phone:732-786-4804
Mailing Address - Fax:
Practice Address - Street 1:191 US 9 S
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8233
Practice Address - Country:US
Practice Address - Phone:732-786-4804
Practice Address - Fax:732-612-5110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1447726856OtherINDIVIDUAL NPI
NJ44SC05977000OtherLCSW