Organization
MODERN THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON CHRISTENSEN (EXECUTIVE DIRECTOR)
(732) 585-7814
Entity
Organization
Contact information
Practice address
1 MAIN ST STE 314, EATONTOWN, NJ 07724-3905
(800) 605-0612
(800) 605-0612
Mailing address
1 MAIN ST STE 314, EATONTOWN, NJ 07724-3905
(800) 605-0612
(800) 605-0612
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0450193127
OUT OF NETWORK
NJ
Enumeration date
08/31/2017
Last updated
12/28/2021
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