Provider Demographics
NPI:1033238712
Name:GLENELLYN COMMUNICATIONS, INC.
Entity Type:Organization
Organization Name:GLENELLYN COMMUNICATIONS, INC.
Other - Org Name:PRIVATE PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CCMHC
Authorized Official - Phone:973-345-8410
Mailing Address - Street 1:26 QUARTZ LN
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3343
Mailing Address - Country:US
Mailing Address - Phone:973-345-8410
Mailing Address - Fax:
Practice Address - Street 1:933 STATE RT 23
Practice Address - Street 2:STE 4
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-1047
Practice Address - Country:US
Practice Address - Phone:973-345-8410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00056700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty