Provider Demographics
NPI:1881235497
Name:CBT AND PSYCHODYNAMIC THERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:CBT AND PSYCHODYNAMIC THERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER (LICENSED IN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, DPHIL LCSW
Authorized Official - Phone:201-321-4334
Mailing Address - Street 1:245 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-321-4334
Mailing Address - Fax:
Practice Address - Street 1:245 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-321-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty