Provider Demographics
NPI:1336294230
Name:COMMUNITY COUNSELING SERVICES OF NORTHERN NEW JERSEY
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICES OF NORTHERN NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREGNOI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC
Authorized Official - Phone:201-585-2477
Mailing Address - Street 1:2083 CENTER AVE SUITE 3H
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-585-2477
Mailing Address - Fax:201-585-2807
Practice Address - Street 1:2083 CENTER AVE SUITE 3H
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-585-2477
Practice Address - Fax:201-585-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0112305Medicaid