Provider Demographics
NPI:1407462179
Name:INTEGRATED COUNSELING SERVICE
Entity Type:Organization
Organization Name:INTEGRATED COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALMANZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:917-364-0303
Mailing Address - Street 1:321 79TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5644
Mailing Address - Country:US
Mailing Address - Phone:917-364-0303
Mailing Address - Fax:
Practice Address - Street 1:321 79TH ST
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5644
Practice Address - Country:US
Practice Address - Phone:917-364-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)