Provider Demographics
NPI:1811157670
Name:FAMILY THERAPY ASSOCIATES, LLC
Entity type:Organization
Organization Name:FAMILY THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:KANCE
Authorized Official - Last Name:BROLIN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, C, MA, CNS
Authorized Official - Phone:609-439-7517
Mailing Address - Street 1:395 RIDGE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1398
Mailing Address - Country:US
Mailing Address - Phone:609-439-7517
Mailing Address - Fax:732-438-1660
Practice Address - Street 1:395 RIDGE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1398
Practice Address - Country:US
Practice Address - Phone:609-439-7517
Practice Address - Fax:732-438-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNRO4738000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty