Provider Demographics
NPI:1861910747
Name:MODERN THERAPY, LLC
Entity type:Organization
Organization Name:MODERN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-585-7814
Mailing Address - Street 1:1 MAIN ST STE 314
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3905
Mailing Address - Country:US
Mailing Address - Phone:800-605-0612
Mailing Address - Fax:800-605-0612
Practice Address - Street 1:1 MAIN ST STE 314
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3905
Practice Address - Country:US
Practice Address - Phone:800-605-0612
Practice Address - Fax:800-605-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450193127OtherOUT OF NETWORK