Provider Demographics
NPI:1881038636
Name:AFFINITY PSYCHOTHERAPY ASSOCIATES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:AFFINITY PSYCHOTHERAPY ASSOCIATES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PSYCHOTHERAPY PRACTICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:TOMACHEK-CERNY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:973-476-4443
Mailing Address - Street 1:4 ROLLING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4532
Mailing Address - Country:US
Mailing Address - Phone:973-476-4443
Mailing Address - Fax:862-244-4628
Practice Address - Street 1:43 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7508
Practice Address - Country:US
Practice Address - Phone:973-476-4443
Practice Address - Fax:862-244-4628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051986001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty