Provider Demographics
NPI:1265660377
Name:ESTHER GANZ, LLC
Entity Type:Organization
Organization Name:ESTHER GANZ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED,LPC,LCADC
Authorized Official - Phone:732-995-1246
Mailing Address - Street 1:80 SCENIC DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5210
Mailing Address - Country:US
Mailing Address - Phone:732-995-1246
Mailing Address - Fax:
Practice Address - Street 1:80 SCENIC DR
Practice Address - Street 2:SUITE 2
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-5210
Practice Address - Country:US
Practice Address - Phone:732-995-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00032300101YA0400X
NJ37PC00104700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLIC#37PC00104700OtherINDIVIDUAL NPI #170681934