Provider Demographics
NPI:1144024001
Name:VITAL FOCUS THERAPY, LLC
Entity type:Organization
Organization Name:VITAL FOCUS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LCSW
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-283-0186
Mailing Address - Street 1:452 N BROADWAY APT 2
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1020
Mailing Address - Country:US
Mailing Address - Phone:856-283-0186
Mailing Address - Fax:
Practice Address - Street 1:452 N BROADWAY APT 2
Practice Address - Street 2:
Practice Address - City:GLOUCESTER CITY
Practice Address - State:NJ
Practice Address - Zip Code:08030-1020
Practice Address - Country:US
Practice Address - Phone:856-283-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427710201OtherNPI