Provider Demographics
NPI:1306177761
Name:M&S INTEGRATED PSYCHOTHERAPY AND COUNSELING LLC
Entity Type:Organization
Organization Name:M&S INTEGRATED PSYCHOTHERAPY AND COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:973-341-9869
Mailing Address - Street 1:555 PREAKNESS AVE
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1012
Mailing Address - Country:US
Mailing Address - Phone:973-341-9869
Mailing Address - Fax:973-689-7271
Practice Address - Street 1:555 PREAKNESS AVE
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07502-1012
Practice Address - Country:US
Practice Address - Phone:973-341-9869
Practice Address - Fax:973-689-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00360100101YP2500X
NJ44SC053074001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162426Medicaid