Provider Demographics
NPI:1952757387
Name:PIECE BY PIECE THERAPEUTICS
Entity type:Organization
Organization Name:PIECE BY PIECE THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN NEST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-625-4479
Mailing Address - Street 1:420 BOULEVARD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1742
Mailing Address - Country:US
Mailing Address - Phone:908-625-4479
Mailing Address - Fax:
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 207
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:908-625-4479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05467900251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health