Provider Demographics
NPI:1144863622
Name:THE TRANSFORMATION CENTER
Entity type:Organization
Organization Name:THE TRANSFORMATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-556-8210
Mailing Address - Street 1:122 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4038
Mailing Address - Country:US
Mailing Address - Phone:201-556-8210
Mailing Address - Fax:201-483-8071
Practice Address - Street 1:122 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4038
Practice Address - Country:US
Practice Address - Phone:201-556-8210
Practice Address - Fax:201-483-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty