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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