Provider Demographics
NPI:1891230470
Name:COR SUPPORT LLC
Entity Type:Organization
Organization Name:COR SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RULE SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-564-7331
Mailing Address - Street 1:294 HARRINGTON AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1912
Mailing Address - Country:US
Mailing Address - Phone:201-564-7331
Mailing Address - Fax:201-564-7337
Practice Address - Street 1:294 HARRINGTON AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1912
Practice Address - Country:US
Practice Address - Phone:201-564-7331
Practice Address - Fax:201-564-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1083950471103TC0700X
NJ18214136261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty