Organization Name: | ANXIETY TREATMENT CENTER, LLC. |
NPI Number: | 1356760813 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICHARD G. WAGNER (OWNER) |
Mailing Address: | 15 Patriots Path South Bound Brook |
State: | NJ US |
Postal Code: | 088801495 |
Phone Number: | 2159620701 |
Fax Number: | 7323561883 |
NPI Enumeration Date: | 04/14/2014 |
NPI Last Update Date: | 04/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 44SC05343200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |