Provider Demographics
NPI:1699815126
Name:AT HOME MARITAL AND FAMILY COUNSELING SERVICE
Entity Type:Organization
Organization Name:AT HOME MARITAL AND FAMILY COUNSELING SERVICE
Other - Org Name:LORRAINE BARRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED MFT SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:EDS
Authorized Official - Phone:732-787-2010
Mailing Address - Street 1:6 BRUNSWICK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5601
Mailing Address - Country:US
Mailing Address - Phone:732-787-2010
Mailing Address - Fax:732-787-1043
Practice Address - Street 1:6 BRUNSWICK WOODS DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5601
Practice Address - Country:US
Practice Address - Phone:732-787-2010
Practice Address - Fax:732-787-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJF1001437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0017906Medicaid