Provider Demographics
NPI:1801191192
Name:BERGEN ALLIANCE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:BERGEN ALLIANCE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:COSENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW, LCSW
Authorized Official - Phone:973-955-8137
Mailing Address - Street 1:85 HOPPER AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1517
Mailing Address - Country:US
Mailing Address - Phone:973-955-8137
Mailing Address - Fax:973-767-1147
Practice Address - Street 1:85 HOPPER AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1517
Practice Address - Country:US
Practice Address - Phone:201-445-7448
Practice Address - Fax:973-767-1147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054271001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty