Provider Demographics
NPI:1922420421
Name:ALTA COUNSELING CENTER
Entity Type:Organization
Organization Name:ALTA COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:BIZZARRO
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LMFT
Authorized Official - Phone:973-239-0011
Mailing Address - Street 1:110 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-1318
Mailing Address - Country:US
Mailing Address - Phone:973-239-0011
Mailing Address - Fax:
Practice Address - Street 1:110 FAIRVIEW AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1318
Practice Address - Country:US
Practice Address - Phone:973-239-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00107600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty