Provider Information for 1306479712
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ESCALATOR COUNSELING SERVICES, LLC
Organization Subpart: NO
NPI: 1306479712
Last Updated: 2020-02-14
Certification Date: 2020-02-14
Certification Date: 2020-02-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1306479712 | ||||||||
| Enumeration Date | 2020-02-14 | ||||||||
| NPI Type | NPI-2 Organization | ||||||||
| Status | Active | ||||||||
| Authorized Official Information | Name: LAURA HENNESSY LCSW, LCADC Title: Co-Owner Phone: 7334164459 | ||||||||
| Mailing Address | 42 LIVINGSTON LN MANALAPAN, NJ 07726-2820 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 2517 HIGHWAY 35 STE 205 MANASQUAN, NJ 08736-1933 United States Phone: 732-416-4459 | Fax: | ||||||||
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