Provider Demographics
NPI:1568755494
Name:BURKE AND UNGER LIFEWORKS COUNSELING LLC
Entity Type:Organization
Organization Name:BURKE AND UNGER LIFEWORKS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:973-930-5507
Mailing Address - Street 1:562 KINGSLAND ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1069
Mailing Address - Country:US
Mailing Address - Phone:973-441-0886
Mailing Address - Fax:973-860-1326
Practice Address - Street 1:562 KINGSLAND ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1069
Practice Address - Country:US
Practice Address - Phone:973-441-0886
Practice Address - Fax:973-860-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000413001041C0700X
NJ44SC054944001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ053835OtherMEDICARE PTAN
NJ053835YHEQOtherGROUP PTAN:
NJ239169YHEQMedicare PIN