Provider Demographics
NPI:1558115816
Name:SAFETY NET FOR SUBSTANCE USE DISORDERS LLC
Entity Type:Organization
Organization Name:SAFETY NET FOR SUBSTANCE USE DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-908-6023
Mailing Address - Street 1:614 BORRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1804
Mailing Address - Country:US
Mailing Address - Phone:732-908-6023
Mailing Address - Fax:
Practice Address - Street 1:2640 ROUTE 70 BLDG 7A
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2609
Practice Address - Country:US
Practice Address - Phone:732-908-6023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty