Provider Demographics
NPI:1992215834
Name:PMA FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:PMA FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASCIUTTO
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-273-7548
Mailing Address - Street 1:214 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1540
Mailing Address - Country:US
Mailing Address - Phone:609-273-7548
Mailing Address - Fax:
Practice Address - Street 1:214 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1540
Practice Address - Country:US
Practice Address - Phone:609-273-7548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05474200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty