Healthcare Provider Details

I. General information

NPI: 1689326233
Provider Name (Legal Business Name): NEW BRUNSWICK COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUYDAM ST
NEW BRUNSWICK NJ
08901-2417
US

IV. Provider business mailing address

320 SUYDAM ST
NEW BRUNSWICK NJ
08901-2417
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-4025
  • Fax: 732-246-1214
Mailing address:
  • Phone: 732-246-4025
  • Fax: 732-246-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA LUTOMSKI
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, LCADC
Phone: 732-246-4025