Provider Demographics
NPI:1902396104
Name:TRAUMA-INFORMED PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:TRAUMA-INFORMED PSYCHOTHERAPY, LLC
Other - Org Name:TRAUMA-INFORMED PSYCHOTHERAPY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-377-8710
Mailing Address - Street 1:45 BAYLISS ST # 2
Mailing Address - Street 2:
Mailing Address - City:NORTH ARLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07031-5548
Mailing Address - Country:US
Mailing Address - Phone:201-377-8710
Mailing Address - Fax:
Practice Address - Street 1:101 PARK ST # 3
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2963
Practice Address - Country:US
Practice Address - Phone:973-447-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056820001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty