Provider Demographics
NPI:1568043354
Name:JERSEY SHORE BEHAVIORAL GROUP
Entity Type:Organization
Organization Name:JERSEY SHORE BEHAVIORAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:LOGRASSO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:848-240-8955
Mailing Address - Street 1:662 ROLLING HILLS CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1177
Mailing Address - Country:US
Mailing Address - Phone:848-240-8955
Mailing Address - Fax:
Practice Address - Street 1:2517 HIGHWAY 35 STE C102
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1910
Practice Address - Country:US
Practice Address - Phone:848-240-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty