Provider Demographics
NPI:1255792982
Name:ENDEAVOR THERAPY GROUP LLC
Entity type:Organization
Organization Name:ENDEAVOR THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:201-888-3462
Mailing Address - Street 1:6 HEGNER CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-1701
Mailing Address - Country:US
Mailing Address - Phone:201-888-3462
Mailing Address - Fax:
Practice Address - Street 1:6 HEGNER CT
Practice Address - Street 2:
Practice Address - City:SOUTH HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07606-1701
Practice Address - Country:US
Practice Address - Phone:201-888-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05888100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health