Provider Demographics
NPI:1497141154
Name:TRI-COUNTY BEHAVIORAL CARE, LLC
Entity Type:Organization
Organization Name:TRI-COUNTY BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:CLARE
Authorized Official - Last Name:CANZONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-691-3030
Mailing Address - Street 1:21 US HIGHWAY 206
Mailing Address - Street 2:#2
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-3275
Mailing Address - Country:US
Mailing Address - Phone:973-691-3030
Mailing Address - Fax:
Practice Address - Street 1:21 US HIGHWAY 206
Practice Address - Street 2:#2
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-3275
Practice Address - Country:US
Practice Address - Phone:973-691-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052837001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty