Provider Demographics
NPI:1316377187
Name:BRAIN HEALTH CENTER LLC
Entity Type:Organization
Organization Name:BRAIN HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:848-404-9111
Mailing Address - Street 1:3100 ROUTE 138
Mailing Address - Street 2:BUILDING 3, SUITE 1
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-9020
Mailing Address - Country:US
Mailing Address - Phone:848-404-9111
Mailing Address - Fax:
Practice Address - Street 1:3100 ROUTE 138
Practice Address - Street 2:BUILDING 3, SUITE 1
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-9020
Practice Address - Country:US
Practice Address - Phone:848-404-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00150500101YA0400X
NJ37LC00205700101YA0400X
NJ37PC00371300101YP2500X
NJ37PC00874000101YP2500X
NJ44SC055467001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty