MEDICARE: PARTNERS FOR HOPE

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	44SL05576000	NJ

General Provider Information

NPI Number	:	1689883001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARTNERS FOR HOPE

Provider Business Mailing Address
First Line	:	365 RIFLE CAMP RD
Second Line	:	SUITE 201
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2726
Country	:	US
Telephone Number	:	201-321-0911
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 RIFLE CAMP RD
Second Line	:	SUITE 201
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2726
Country	:	US
Telephone Number	:	201-321-0911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. QUINCEY S HOLLOWAY
Credential	:	LSW
Telephone Number	:	201-321-0911

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	04/10/2014

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Directions to “PARTNERS FOR HOPE ” Practice Location

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