Provider Demographics
NPI:1578699070
Name:MAIN STREET COUNSELING SERVICE
Entity Type:Organization
Organization Name:MAIN STREET COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUGUID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-736-2041
Mailing Address - Street 1:8 MARCELLA AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-736-2041
Mailing Address - Fax:973-669-9683
Practice Address - Street 1:8 MARCELLA AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-736-2041
Practice Address - Fax:973-669-9683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0045128Medicaid
NJA2721786OtherOXFORD
NJA2721786OtherOXFORD