=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255841631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POSITIVE APPROACHES COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2017
-----------------------------------------------------
Last Update Date | 10/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 MIDVALE RD STE 1E
-----------------------------------------------------
City | MOUNTAIN LAKES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07046-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-464-5005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 MIDVALE RD STE 1E
-----------------------------------------------------
City | MOUNTAIN LAKES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07046-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW
-----------------------------------------------------
Name | TONI M MANZIONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-464-5005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 37LC00157000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05380100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------