Provider Demographics
NPI:1376851717
Name:CLIENT-FOCUSED FAMILY COUNSELING
Entity Type:Organization
Organization Name:CLIENT-FOCUSED FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:732-996-9072
Mailing Address - Street 1:32 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3526
Mailing Address - Country:US
Mailing Address - Phone:732-996-9072
Mailing Address - Fax:732-530-4534
Practice Address - Street 1:32 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3526
Practice Address - Country:US
Practice Address - Phone:732-996-9072
Practice Address - Fax:732-530-4534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00315100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169960Medicaid