MEDICARE: MR. JASON MICHAEL ANDREACH LCSW

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	44SC04571500	NJ
2	1041C0700X	Clinical Social Worker	44SC04571500	NJ

General Provider Information

NPI Number	:	1740258193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON MICHAEL ANDREACH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1926
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08723-1071
Country	:	US
Telephone Number	:	732-701-0440
Fax Number	:	732-701-0419

Provider Business Practice Location Address
First Line	:	2424 BRIDGE AVE. SUITE 4
Second Line	:	ANDREACH & PAULSEN COUNSELING GROUP LLC
City	:	POINT PLEASANT
State	:	NJ
Zip	:	08742
Country	:	US
Telephone Number	:	732-903-7012
Fax Number	:	732-903-7135

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	09/15/2015

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