MEDICARE: JUST BETWEEN GIRLS

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	251S00000X	Community/Behavioral Health Agency	37PC00431600	NJ

General Provider Information

NPI Number	:	1518355940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST BETWEEN GIRLS

Provider Business Mailing Address
First Line	:	1510 DORSET DOCK RD
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-4347
Country	:	US
Telephone Number	:	848-448-1680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 BEAVER DAM RD
Second Line	:	SUITE 100
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-5171
Country	:	US
Telephone Number	:	848-448-1680
Fax Number	:

Authorized Official
Title or Position	:	COUNSELOR
Name	:	STEPHANIE B ANILO
Credential	:	LPC
Telephone Number	:	848-448-1690

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	10/13/2015

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