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Organization
MODERN MIND THERAPEUTIC SERVICES LLC
Active
Organization
MODERN MIND THERAPEUTIC SERVICES LLC
Active
Other names
Modern Mind Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA AYALA LCSW (THERAPIST/ OWNER)
(973) 930-9749
Entity
Organization
Contact information
Practice address
49 KULICK ST, CLIFTON, NJ 07011-2375
(973) 930-9749
Mailing address
1114 MAIN AVE UNIT 6035, CLIFTON, NJ 07015-7200
(973) 910-0900
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
03/12/2021
Last updated
03/12/2021
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