Provider Demographics
NPI:1568556736
Name:GENERATIONS COUNSELING & CARE MANAGEMENT LLC
Entity Type:Organization
Organization Name:GENERATIONS COUNSELING & CARE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOUECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-845-7030
Mailing Address - Street 1:336 W PASSAIC ST
Mailing Address - Street 2:4TH FL
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3027
Mailing Address - Country:US
Mailing Address - Phone:201-845-7030
Mailing Address - Fax:201-845-0899
Practice Address - Street 1:336 W PASSAIC ST
Practice Address - Street 2:4TH FL
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3027
Practice Address - Country:US
Practice Address - Phone:201-845-7030
Practice Address - Fax:201-845-0899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS COUNSELING & CARE MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2007-11-29
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
NJ055039Medicare PIN