Healthcare Provider Details

I. General information

NPI: 1659545358
Provider Name (Legal Business Name): MARIA VERNACHIO COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 ATLANTIC CITY BLVD
BEACHWOOD NJ
08722-4007
US

IV. Provider business mailing address

625 ATLANTIC CITY BLVD
BEACHWOOD NJ
08722-4007
US

V. Phone/Fax

Practice location:
  • Phone: 732-737-1158
  • Fax: 848-480-2833
Mailing address:
  • Phone: 732-737-1158
  • Fax: 848-480-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number44SC01304300
License Number StateNJ

VIII. Authorized Official

Name: MARIA VERNACHIO
Title or Position: LCSW
Credential: MSW, LCSW
Phone: 732-737-1158