Provider Demographics
NPI:1609380013
Name:ESTHER LEGACY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:ESTHER LEGACY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:YOHANNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALDERRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-562-8931
Mailing Address - Street 1:39 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1107
Mailing Address - Country:US
Mailing Address - Phone:201-562-8931
Mailing Address - Fax:
Practice Address - Street 1:121 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4457
Practice Address - Country:US
Practice Address - Phone:201-429-5081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1041C0700X
NJ44SC05657400261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty