NPI 1962008250 · live from the CMS NPI Registry
490 Counseling
Social Worker, Clinical in Eatontown, NJ. National Provider Identifier 1962008250, active.
NPI record
| NPI | 1962008250 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Social Worker, Clinical 1041C0700X |
| Practice location | 48b Southbrook Dr, Eatontown, NJ 07724 |
| Practice phone | 973-862-3111 |
| Enumerated | December 10, 2020 |
| Last updated | December 10, 2020 |
| Authorized official | Julianna Calleo, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health | 101YM0800X | — |
| Clinic/Center, Mental Health (Including Community Mental Health Center) | 261QM0801X | — |
| Social Worker, Clinical primary | 1041C0700X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.