Provider Demographics
NPI:1275871899
Name:FOSTER, B. MICHELLE (MA, LAC, EDD)
Entity Type:Individual
Prefix:DR
First Name:B.
Middle Name:MICHELLE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MA, LAC, EDD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:MICHELLE
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LAC, EDD
Mailing Address - Street 1:2100 ROUTE 33
Mailing Address - Street 2:SUITE 9-10
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6102
Mailing Address - Country:US
Mailing Address - Phone:732-988-3441
Mailing Address - Fax:732-988-7123
Practice Address - Street 1:2100 ROUTE 33
Practice Address - Street 2:SUITE 9-10
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6102
Practice Address - Country:US
Practice Address - Phone:732-988-3441
Practice Address - Fax:732-988-7123
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00048600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor