Provider Demographics
NPI:1750651881
Name:BASKING RIDGE COUNSELING AND THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:BASKING RIDGE COUNSELING AND THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:908-647-6611
Mailing Address - Street 1:59 E RAYBURN RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07946-1503
Mailing Address - Country:US
Mailing Address - Phone:908-647-6611
Mailing Address - Fax:908-647-5013
Practice Address - Street 1:59 E RAYBURN RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07946-1503
Practice Address - Country:US
Practice Address - Phone:908-647-6611
Practice Address - Fax:908-647-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI02353103TC0700X
NJSC002751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRO66440Medicare PIN
NJRO641816Medicare PIN