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General NPI Number Information
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NPI Number | 1497297766
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Entity Type | Organization
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Legal Business Name | COUNSELING & THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 450 TILTON RD STE 250
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1260
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Country | US
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Telephone | 609-334-4992
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Fax |
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Provider Business Mailing Address
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Address Line | 19 WABASH AVE
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City | LINWOOD
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State | NJ
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Zip | 08221-2000
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Country | US
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Telephone | 609-816-6670
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | KATHLEEN SIRACUSA
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Credential | LCSW
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Telephone | 609-816-6670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 44SC05441000
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License Number State | NJ
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