Provider Demographics
NPI:1700538485
Name:SAFE SPACE TALK
Entity Type:Organization
Organization Name:SAFE SPACE TALK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:929-333-6813
Mailing Address - Street 1:1301 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-2301
Mailing Address - Country:US
Mailing Address - Phone:929-333-6813
Mailing Address - Fax:
Practice Address - Street 1:1301 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-2301
Practice Address - Country:US
Practice Address - Phone:929-333-6813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1053831768OtherINDIVIDUAL NPI