Provider Demographics
NPI:1720657604
Name:VIVID PATHWAYS PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:VIVID PATHWAYS PSYCHOTHERAPY, LLC
Other - Org Name:VIVID PATHWAYS PSYCHOTHERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:732-290-5960
Mailing Address - Street 1:250 SCHOOLEYS MOUNTAIN RD # 38
Mailing Address - Street 2:
Mailing Address - City:SCHOOLEYS MTN
Mailing Address - State:NJ
Mailing Address - Zip Code:07870-9800
Mailing Address - Country:US
Mailing Address - Phone:732-290-5960
Mailing Address - Fax:
Practice Address - Street 1:250 SCHOOLEYS MOUNTAIN RD # 38
Practice Address - Street 2:
Practice Address - City:SCHOOLEYS MTN
Practice Address - State:NJ
Practice Address - Zip Code:07870-9800
Practice Address - Country:US
Practice Address - Phone:732-290-5960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)