Healthcare Provider Details

I. General information

NPI: 1891230470
Provider Name (Legal Business Name): COR SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 HARRINGTON AVE SUITE 7
CLOSTER NJ
07624-1912
US

IV. Provider business mailing address

294 HARRINGTON AVE SUITE 7
CLOSTER NJ
07624-1912
US

V. Phone/Fax

Practice location:
  • Phone: 201-564-7331
  • Fax: 201-564-7337
Mailing address:
  • Phone: 201-564-7331
  • Fax: 201-564-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1083950471
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1821413626
License Number StateNJ

VIII. Authorized Official

Name: MRS. KAREN MARIE RULE SUAREZ
Title or Position: CLINICAL DIRECTOR
Credential: LCSW
Phone: 201-564-7331