=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932510187
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADULT, CHILDREN AND FAMILY COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2014
-----------------------------------------------------
Last Update Date | 05/09/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 SOUTH AVE W
-----------------------------------------------------
City | CRANFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07016-2686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-653-0005
-----------------------------------------------------
Fax | 908-653-1806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 SOUTH AVE W
-----------------------------------------------------
City | CRANFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07016-2686
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-653-0005
-----------------------------------------------------
Fax | 908-653-1806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | CARLA GAGLIANO
-----------------------------------------------------
Credential | M.S.W., L.C.S.W.
-----------------------------------------------------
Telephone | 908-653-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC00193300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------