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General NPI Number Information
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NPI Number | 1811416019
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Entity Type | Organization
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Legal Business Name | INTEGRATED CARE CONSULTING LLC
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Dates
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Enumeration Date | 09/19/2017
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 615 HOPE ROAD, BLDG 5B, 2ND FLOOR
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City | EATONTOWN
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State | NJ
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Zip | 07724-1277
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Country | US
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Telephone | 732-389-0697
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Fax | 732-389-0611
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Provider Business Mailing Address
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Address Line | 134 LIGHTHOUSE DR
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City | WARETOWN
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State | NJ
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Zip | 08758-2015
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Country | US
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Telephone | 732-389-0697
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Fax | 732-389-0611
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ELENA HAMMER
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Credential |
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Telephone | 732-389-0697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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