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General NPI Number Information
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NPI Number | 1568043354
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Entity Type | Organization
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Legal Business Name | JERSEY SHORE BEHAVIORAL GROUP
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 2517 HIGHWAY 35 STE C102
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City | MANASQUAN
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State | NJ
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Zip | 08736-1910
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Country | US
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Telephone | 848-240-8955
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Fax |
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Provider Business Mailing Address
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Address Line | 662 ROLLING HILLS CT
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City | BRICK
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State | NJ
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Zip | 08724-1177
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Country | US
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Telephone | 848-240-8955
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JOHN SALVATORE LOGRASSO
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Credential | LCSW
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Telephone | 848-240-8955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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