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General NPI Number Information
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NPI Number | 1790029619
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Entity Type | Organization
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Legal Business Name | THE SAMARITAN CENTER AT THE JERSEY SHORE
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 36 SOUTH ST
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City | MANASQUAN
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State | NJ
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Zip | 08736-3440
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Country | US
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Telephone | 732-223-4673
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Fax | 732-722-7867
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Provider Business Mailing Address
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Address Line | 36 SOUTH ST
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City | MANASQUAN
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State | NJ
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Zip | 08736-3440
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Country | US
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Telephone | 732-223-4673
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Fax | 732-722-7867
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | IRMA GEIB
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Credential | RN
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Telephone | 732-223-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37AC00068100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 37AC00120300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00103300
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00443500
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License Number State | NJ
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