=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518335496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORRIS COUNTY COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2015
-----------------------------------------------------
Last Update Date | 01/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 COLUMBIA TPKE STE 307
-----------------------------------------------------
City | FLORHAM PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07932-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-668-1001
-----------------------------------------------------
Fax | 201-510-0758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 95 W 13TH ST 1ST FLR
-----------------------------------------------------
City | BAYONNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07002-1343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-668-1001
-----------------------------------------------------
Fax | 201-510-0758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MR. BRIAN A NANDY
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 908-219-9008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00350300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------