Provider Demographics
NPI:1497050009
Name:PATHWAYS COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:PATHWAYS COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEG
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-835-6337
Mailing Address - Street 1:16 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1895
Mailing Address - Country:US
Mailing Address - Phone:973-835-6337
Mailing Address - Fax:973-616-4688
Practice Address - Street 1:16 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1895
Practice Address - Country:US
Practice Address - Phone:973-835-6337
Practice Address - Fax:973-616-4688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS COUNSELING CENTER INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1114-05-041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0063681OtherMEDICARE PTAN 66460
NJ0063681Medicaid