Provider Demographics
NPI:1376987735
Name:SUPPORTIVE CARE SERVICES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:SUPPORTIVE CARE SERVICES LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:908-399-4622
Mailing Address - Street 1:9 DANIEL LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-4351
Mailing Address - Country:US
Mailing Address - Phone:908-399-4622
Mailing Address - Fax:908-236-0099
Practice Address - Street 1:9 DANIEL LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-4351
Practice Address - Country:US
Practice Address - Phone:908-399-4622
Practice Address - Fax:908-236-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ251B00000XMedicaid