MEDICARE: MRS. ESTHER H GANZ LPC LCADC

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	37PC00104700	NJ
2	101YM0800X	Mental Health Counselor	37LC00032300	NJ

General Provider Information

NPI Number	:	1770681934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ESTHER H GANZ LPC LCADC

Provider Business Mailing Address
First Line	:	80 SCENIC DR
Second Line	:	SUITE 2
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5211
Country	:	US
Telephone Number	:	732-995-1246
Fax Number	:	732-462-2687

Provider Business Practice Location Address
First Line	:	80 SCENIC DR
Second Line	:	SUITE 2
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5211
Country	:	US
Telephone Number	:	732-995-1246
Fax Number	:	732-462-2687

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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