Provider Demographics
NPI:1356680003
Name:COMMUNITY COUNSELING SERVICE OF SOUTH JERSEY LLC
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING SERVICE OF SOUTH JERSEY LLC
Other - Org Name:KAREN ANN BROOK LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BROOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:856-596-6444
Mailing Address - Street 1:121 W CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8136
Mailing Address - Country:US
Mailing Address - Phone:856-596-6444
Mailing Address - Fax:856-797-8512
Practice Address - Street 1:121 W CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8136
Practice Address - Country:US
Practice Address - Phone:856-596-6444
Practice Address - Fax:856-797-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty