Healthcare Provider Details

I. General information

NPI: 1205509643
Provider Name (Legal Business Name): CARING COUNSELING & PSYCHIATRY GROUP OF NJ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ENTERPRISE DR STE 301
ROCKAWAY NJ
07866-2129
US

IV. Provider business mailing address

17 N PLANK RD STE 10
NEWBURGH NY
12550-2111
US

V. Phone/Fax

Practice location:
  • Phone: 602-703-2801
  • Fax: 844-800-1470
Mailing address:
  • Phone: 845-800-9305
  • Fax: 844-800-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: YVONNE PASQUALICCHIO
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: MA ED
Phone: 845-800-9305