Provider Demographics
NPI:1235359779
Name:ANDERSCH, VIVIAN C (LCADC,CCS,CJC,CCGC,L)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:C
Last Name:ANDERSCH
Suffix:
Gender:F
Credentials:LCADC,CCS,CJC,CCGC,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7469
Mailing Address - Country:US
Mailing Address - Phone:732-244-1600
Mailing Address - Fax:732-349-5532
Practice Address - Street 1:270 CHAMBERSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-2805
Practice Address - Country:US
Practice Address - Phone:732-920-2700
Practice Address - Fax:732-262-0707
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00053100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional