MEDICARE: EMBRACING CHANGE COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1821645078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBRACING CHANGE COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	154 JEWETT AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07304-2004
Country	:	US
Telephone Number	:	201-892-7651
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S LIVINGSTON AVE STE 205D
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-3929
Country	:	US
Telephone Number	:	201-367-1667
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ CLINICIAN
Name	:	ERICA N CANNEDY
Credential	:	LPC, LCADC
Telephone Number	:	201-367-1667

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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