Healthcare Provider Details

I. General information

NPI: 1336653633
Provider Name (Legal Business Name): COUNSELING CENTER OF ESSEX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 10/29/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 POMPTON AVE BLDG 3 - FLOOR 1
CEDAR GROVE NJ
07009-1043
US

IV. Provider business mailing address

1425 POMPTON AVE BLDG 3 FLOOR 1
CEDAR GROVE NJ
07009-1043
US

V. Phone/Fax

Practice location:
  • Phone: 973-997-9201
  • Fax:
Mailing address:
  • Phone: 973-997-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00302100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00119100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DORIS M DINALLO
Title or Position: COUNSELOR
Credential: RN, LCADC,LPC,BCPC
Phone: 973-997-9201