Provider Demographics
NPI:1518909837
Name:LONG BEACH ISLAND COMMUNITY CENTER, INC.
Entity Type:Organization
Organization Name:LONG BEACH ISLAND COMMUNITY CENTER, INC.
Other - Org Name:ST. FRANCIS COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAZLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:609-494-1554
Mailing Address - Street 1:4700 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-3926
Mailing Address - Country:US
Mailing Address - Phone:609-494-1554
Mailing Address - Fax:609-361-9653
Practice Address - Street 1:4700 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08008-3926
Practice Address - Country:US
Practice Address - Phone:609-494-1554
Practice Address - Fax:609-361-9653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0094251Medicaid