Provider Demographics
NPI:1639834765
Name:RISING UP COUNSELING
Entity Type:Organization
Organization Name:RISING UP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:EBID
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-889-0888
Mailing Address - Street 1:40-14 KNOTT TER
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5322
Mailing Address - Country:US
Mailing Address - Phone:201-889-0888
Mailing Address - Fax:
Practice Address - Street 1:40-14 KNOTT TER
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5322
Practice Address - Country:US
Practice Address - Phone:201-889-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1134767106Medicaid