Provider Demographics
NPI:1972192102
Name:SPROUTING SOLUTIONS PSYCHOTHERAPY
Entity Type:Organization
Organization Name:SPROUTING SOLUTIONS PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHENELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIWARDENA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-631-4297
Mailing Address - Street 1:290 US HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1808
Mailing Address - Country:US
Mailing Address - Phone:732-631-4297
Mailing Address - Fax:
Practice Address - Street 1:290 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1808
Practice Address - Country:US
Practice Address - Phone:732-631-4297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)