Provider Demographics
NPI:1114453313
Name:PRIVATE CARE MANAGEMENT AND CONSULTATION SERVICES LLC
Entity Type:Organization
Organization Name:PRIVATE CARE MANAGEMENT AND CONSULTATION SERVICES LLC
Other - Org Name:PRIVATE CARE MANAGEMENT, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-419-0395
Mailing Address - Street 1:50 NORTHFIELD AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5320
Mailing Address - Country:US
Mailing Address - Phone:973-419-0395
Mailing Address - Fax:973-676-6939
Practice Address - Street 1:50 NORTHFIELD AVE
Practice Address - Street 2:STE 4
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5320
Practice Address - Country:US
Practice Address - Phone:973-419-0395
Practice Address - Fax:973-676-6939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05614400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health