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General NPI Number Information
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NPI Number | 1265629182
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Entity Type | Organization
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Legal Business Name | GROWTH COUNSELING CENTER
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 10 W SOUTH ORANGE AVE
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1728
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Country | US
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Telephone | 973-688-8858
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Fax | 973-368-8859
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Provider Business Mailing Address
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Address Line | 10 W SOUTH ORANGE AVE FL 2
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1728
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Country | US
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Telephone | 973-688-8858
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MS. CARIN MARTUCCI
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Credential |
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Telephone | 973-688-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05264700
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License Number State | NJ
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