=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295205839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPATIONAL CENTER OF UNION COUNTY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2018
-----------------------------------------------------
Last Update Date | 11/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 COX ST
-----------------------------------------------------
City | ROSELLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07203-1797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-241-7200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 COX ST
-----------------------------------------------------
City | ROSELLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07203-1797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-241-7200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT CEO
-----------------------------------------------------
Name | MICHELE N FORD
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 908-241-7200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------