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General NPI Number Information
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NPI Number | 1083223218
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTHCARE CONNECTIONS OF NEW JERSEY, LLC
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 07/23/2020
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Provider Practice Location Address
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Address Line | 715 21ST AVE
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City | LAKE COMO
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State | NJ
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Zip | 07719-2926
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Country | US
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Telephone | 732-586-1054
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 152
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City | BELMAR
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State | NJ
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Zip | 07719-0152
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Country | US
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Telephone | 732-586-1054
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. SEAN S. LEE
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Credential | LSW
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Telephone | 732-586-1054
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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