=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457835472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGINGWELL COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2018
-----------------------------------------------------
Last Update Date | 09/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 DAN LY WAY RD
-----------------------------------------------------
City | CALIFON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07830-4009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-310-7851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 58
-----------------------------------------------------
City | CALIFON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07830-0058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-310-7851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | MRS. KRISTEN L BARKMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 908-310-7851
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------