Provider Demographics
NPI:1225406762
Name:CONGREGATION TORATH CHAIM RAINTREE
Entity Type:Organization
Organization Name:CONGREGATION TORATH CHAIM RAINTREE
Other - Org Name:CCC COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEDIEDJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUES-PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:RABBI, LCSW, LCADC
Authorized Official - Phone:609-225-9355
Mailing Address - Street 1:1212 TODD CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2256
Mailing Address - Country:US
Mailing Address - Phone:732-814-4648
Mailing Address - Fax:609-225-9355
Practice Address - Street 1:1401 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1121
Practice Address - Country:US
Practice Address - Phone:609-225-9355
Practice Address - Fax:609-225-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05605500251S00000X
NJ37LC0021100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1720329576OtherNPI