NPIMap

Organization Active NPI

Empowerment Through Adventure LLC

  • Clinical Social Worker
  • Westmont, NJ
National Provider Identifier
1114041332
Registry record updated Apr 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05230400 Issued in NJ
Legal business name
EMPOWERMENT THROUGH ADVENTURE LLC
Practice address
86 Elgin Avenue
Westmont, NJ 08108
Phone
(609) 828-2110
Fax
(856) 854-5423
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Jennifer K Wirth, LCSWNPI 1851566533
Title
Owner
Phone
(609) 828-2110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 44SC05230400 NJ Primary

Addresses

Primary practice location

86 Elgin Avenue
Westmont, NJ 08108

Mailing address

86 Elgin Avenue
Westmont, NJ 08108
Phone (609) 828-2110

Other identifiers 3

IdentifierTypeStateIssuer
0037494MedicaidNJ
0030856MedicaidNJ
0031101MedicaidNJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1114041332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 ELGIN AVENUE",
            "city": "WESTMONT",
            "state": "NJ",
            "postal_code": "08108",
            "telephone_number": "609-828-2110",
            "fax_number": "856-869-2830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 ELGIN AVENUE",
            "city": "WESTMONT",
            "state": "NJ",
            "postal_code": "08108",
            "telephone_number": "609-828-2110",
            "fax_number": "856-854-5423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWERMENT THROUGH ADVENTURE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "WIRTH",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-828-2110",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05230400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0037494",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0030856",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031101",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Westmont, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.