MEDICARE: LAKEWOOD COMMUNITY SERVICES CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053657635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEWOOD COMMUNITY SERVICES CORP.

Provider Business Mailing Address
First Line	:	900 FOREST AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2620
Country	:	US
Telephone Number	:	732-901-6001
Fax Number	:	732-364-7627

Provider Business Practice Location Address
First Line	:	225 4TH ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3228
Country	:	US
Telephone Number	:	732-901-6001
Fax Number	:	732-364-7627

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOSHE WEISBERG
Credential	:
Telephone Number	:	732-901-6001

Provider Enumeration Date	:	12/29/2012
Last Update Date	:	01/15/2020

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