NPIMap

Organization Active NPI

Modern Therapy, LLC

  • Psychologist
  • Eatontown, NJ
National Provider Identifier
1861910747
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MODERN THERAPY, LLC
Practice address
1 Main St Ste 314
Eatontown, NJ 07724-3905
Phone
(800) 605-0612
Fax
(800) 605-0612
NPI assigned
Aug 31, 2017
Last updated
Dec 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2021

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

Authorized official

Name
Brandon Christensen
Title
Executive Director
Phone
(732) 585-7814

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

1 Main St Ste 314
Eatontown, NJ 07724-3905

Mailing address

1 Main St Ste 314
Eatontown, NJ 07724-3905
Phone (800) 605-0612

Other identifiers 1

IdentifierTypeStateIssuer
0450193127OtherNJOUT OF NETWORK

National Provider Directory

National Provider Directory

Locations

1 Main St
Ste 314
Eatontown, NJ 07724
Phone (484) 626-1202

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1504137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640649600000",
    "number": "1861910747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MAIN ST STE 314",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077243905",
            "telephone_number": "800-605-0612",
            "fax_number": "800-605-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST STE 314",
            "city": "EATONTOWN",
            "state": "NJ",
            "postal_code": "077243905",
            "telephone_number": "800-605-0612",
            "fax_number": "800-605-0612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-31",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "732-585-7814"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUT OF NETWORK",
            "identifier": "0450193127",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eatontown, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.