Provider Demographics
NPI:1851158935
Name:JDR INTEGRATIVE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:JDR INTEGRATIVE PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:475-244-5253
Mailing Address - Street 1:137 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3357
Mailing Address - Country:US
Mailing Address - Phone:475-244-5253
Mailing Address - Fax:
Practice Address - Street 1:137 BAKER AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3357
Practice Address - Country:US
Practice Address - Phone:475-244-5253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty