Healthcare Provider Details

I. General information

NPI: 1306479712
Provider Name (Legal Business Name): ESCALATOR COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2517 HIGHWAY 35 STE 205
MANASQUAN NJ
08736-1933
US

IV. Provider business mailing address

42 LIVINGSTON LN
MANALAPAN NJ
07726-2820
US

V. Phone/Fax

Practice location:
  • Phone: 732-416-4459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAURA HENNESSY
Title or Position: CO-OWNER
Credential: LCSW, LCADC
Phone: 733-416-4459