MEDICARE: EATING DISORDER & ANXIETY CENTER OF NEW JERSEY

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1649025602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EATING DISORDER & ANXIETY CENTER OF NEW JERSEY

Provider Business Mailing Address
First Line	:	187 BRECKENRIDGE DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-3240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 BRECKENRIDGE DR
Second Line	:
City	:	SICKLERVILLE
State	:	NJ
Zip	:	08081-3240
Country	:	US
Telephone Number	:	215-206-1749
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CLINICAL DIRECTOR
Name	:	GABRIELLE ALYSE MORREALE
Credential	:	M.A. LPC
Telephone Number	:	215-206-1749

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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Directions to “EATING DISORDER & ANXIETY CENTER OF NEW JERSEY ” Practice Location

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