MEDICARE: ANDREACH COUNSELING GROUP LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1851088488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREACH COUNSELING GROUP LLC

Provider Business Mailing Address
First Line	:	2704 SHADY GLEN AVE
Second Line	:
City	:	POINT PLEASANT BORO
State	:	NJ
Zip	:	08742-4245
Country	:	US
Telephone Number	:	732-701-9363
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 HAWTHORNE AVE STE 6
Second Line	:
City	:	POINT PLEASANT BEACH
State	:	NJ
Zip	:	08742-2539
Country	:	US
Telephone Number	:	732-903-7012
Fax Number	:	732-903-7135

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JASON M ANDREACH
Credential	:	LCSW
Telephone Number	:	732-701-9363

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	03/02/2024

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