Provider Demographics
NPI:1558575423
Name:COUNSELING AND REHABILITATION OF NEW JERSEY, INC.
Entity Type:Organization
Organization Name:COUNSELING AND REHABILITATION OF NEW JERSEY, INC.
Other - Org Name:COMMUNITY SKILLS PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNEIPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-596-5122
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-0687
Mailing Address - Country:US
Mailing Address - Phone:856-596-5122
Mailing Address - Fax:
Practice Address - Street 1:5000 SAGEMORE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4307
Practice Address - Country:US
Practice Address - Phone:856-596-5122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5994802Medicaid