Provider Demographics
NPI:1184283921
Name:OPEN ARMS THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:OPEN ARMS THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW, MSW
Authorized Official - Phone:732-600-9356
Mailing Address - Street 1:445 BRICK BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6079
Mailing Address - Country:US
Mailing Address - Phone:732-600-9356
Mailing Address - Fax:
Practice Address - Street 1:445 BRICK BLVD STE 204
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6079
Practice Address - Country:US
Practice Address - Phone:732-600-9356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ942968OtherSTATE OF NEW JERSEY STATE BOARD OF EXAMINERS
NJ44SC05738100OtherSOCIAL WORK EXAMINERS,LIC. CLINICAL SOCIAL WORKER