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General NPI Number Information
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NPI Number | 1295258424
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Entity Type | Organization
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Legal Business Name | CNV COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/19/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 22 COVENTRY DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-3164
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Country | US
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Telephone | 732-735-6725
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Fax |
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Provider Business Mailing Address
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Address Line | 22 COVENTRY DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-3164
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Country | US
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Telephone | 732-735-6725
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | KERRY FARRACE
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Credential | MS, LMFT
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Telephone | 732-735-6725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 37FI00164500
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License Number State | NJ
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