| Trauma-informed Psychotherapy, Llc | |
|
101 Park St # 3 Montclair NJ 07042-2963 | |
| (973) 447-4460 | |
| Not Available |
| Full Name | Trauma-informed Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 101 Park St # 3, Montclair, New Jersey |
| Authorized Official Name and Position | Mark William Richardson (OWNER) |
| Authorized Official Contact | 2013778710 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trauma-informed Psychotherapy, Llc 45 Bayliss St # 2 North Arlington NJ 07031-5548 Ph: (201) 377-8710 | Trauma-informed Psychotherapy, Llc 101 Park St # 3 Montclair NJ 07042-2963 Ph: (973) 447-4460 |
| NPI Number | 1902396104 |
|---|---|
| Provider Enumeration Date | 05/14/2018 |
| Last Update Date | 06/16/2018 |
| Medicare PECOS PAC ID | 7113272790 |
|---|---|
| Medicare Enrollment ID | O20180622000890 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902396104 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 44SC05682000 (New Jersey) | Primary |
| Provider Name | Mark William Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699213785 PECOS PAC ID: 9931454519 Enrollment ID: I20180622001342 |
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