| South Mountain Therapy Llc | |
|
146 Glen Ave Millburn NJ 07041-1722 | |
| (347) 740-5710 | |
| Not Available |
| Full Name | South Mountain Therapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 146 Glen Ave, Millburn, New Jersey |
| Authorized Official Name and Position | Shobha Ayyappan (PSYCHOTHERAPIST) |
| Authorized Official Contact | 3477405710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Mountain Therapy Llc 146 Glen Ave Millburn NJ 07041-1722 Ph: (347) 740-5710 | South Mountain Therapy Llc 146 Glen Ave Millburn NJ 07041-1722 Ph: (347) 740-5710 |
| NPI Number | 1952939944 |
|---|---|
| Provider Enumeration Date | 03/27/2020 |
| Last Update Date | 11/30/2023 |
| Certification Date | 11/30/2023 |
| Medicare PECOS PAC ID | 2961841275 |
|---|---|
| Medicare Enrollment ID | O20240419001048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952939944 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Shobha Ayyappan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1770071359 PECOS PAC ID: 4587003801 Enrollment ID: I20240419001769 |
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