Provider Demographics
NPI:1689955478
Name:CASA RICO, LLC
Entity Type:Organization
Organization Name:CASA RICO, LLC
Other - Org Name:BE WELL COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOLA-RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-548-8533
Mailing Address - Street 1:285 DURHAM AVE
Mailing Address - Street 2:BLDG. #6, STE 2A
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2546
Mailing Address - Country:US
Mailing Address - Phone:908-548-8533
Mailing Address - Fax:908-548-8532
Practice Address - Street 1:285 DURHAM AVE
Practice Address - Street 2:BLDG. #6, STE 2A
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2546
Practice Address - Country:US
Practice Address - Phone:908-548-8533
Practice Address - Fax:908-548-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00339800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty