| Out Of The Box Lcsw, Pllc | |
|
1 Flagship Street Apt 405 Bayonne NJ 07002 | |
| (646) 961-9225 | |
| Not Available |
| Full Name | Out Of The Box Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1 Flagship Street Apt 405, Bayonne, New Jersey |
| Authorized Official Name and Position | Tabitha Ford (OWNER/ CEO) |
| Authorized Official Contact | 6469619225 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Out Of The Box Lcsw, Pllc 1 Flagship St Apt 405 Bayonne NJ 07002-7229 Ph: (646) 961-9225 | Out Of The Box Lcsw, Pllc 1 Flagship Street Apt 405 Bayonne NJ 07002 Ph: (646) 961-9225 |
| NPI Number | 1467180695 |
|---|---|
| Provider Enumeration Date | 08/15/2022 |
| Last Update Date | 04/24/2023 |
| Certification Date | 04/24/2023 |
| Medicare PECOS PAC ID | 8921474784 |
|---|---|
| Medicare Enrollment ID | O20221019001023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467180695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tabitha Ford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982271342 PECOS PAC ID: 6709264377 Enrollment ID: I20220610000198 |
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