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Organization subpart
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Provider details

NPI number
Authorized official
STACY CANCELARICH LCSW (INCORPORATOR)
(917) 670-0469
Entity
Organization

Contact information

Practice address
160 WASHINGTON AVE, HILLSDALE, NJ 07642-2818
(917) 670-0469
Mailing address
160 WASHINGTON AVE, HILLSDALE, NJ 07642-2818

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
44SC05590300
NJ

Other

Enumeration date
07/12/2014
Last updated
07/12/2014
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