Provider Demographics
NPI:1649983750
Name:WILDROSE PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:WILDROSE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMINI
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-921-5060
Mailing Address - Street 1:222 KINDERKAMACK ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649
Mailing Address - Country:US
Mailing Address - Phone:201-921-5060
Mailing Address - Fax:
Practice Address - Street 1:222 KINDERKAMACK ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649
Practice Address - Country:US
Practice Address - Phone:201-921-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty