Provider Demographics
NPI:1659742765
Name:BLUE WATER COUNSELING SERVICES
Entity Type:Organization
Organization Name:BLUE WATER COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GESICKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-597-3424
Mailing Address - Street 1:703 MILL CREEK RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3828
Mailing Address - Country:US
Mailing Address - Phone:609-597-3424
Mailing Address - Fax:609-597-3410
Practice Address - Street 1:703 MILL CREEK RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3828
Practice Address - Country:US
Practice Address - Phone:609-597-3424
Practice Address - Fax:609-597-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055114001041C0700X
NJ44SC055165001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty