Organization
BERGEN CBT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN EDWARD GIANGRASSO PSY.D. (PRESIDENT)
(201) 632-1548
Entity
Organization
Contact information
Practice address
44 GODWIN AVE, MIDLAND PARK, NJ 07432-1969
(201) 632-1548
Mailing address
480 GORDON RD, RIDGEWOOD, NJ 07450-4620
(718) 644-0639
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265805972
—
NY
05
—
1548545411
—
NY
Enumeration date
09/21/2023
Last updated
09/21/2023
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