Provider Demographics
NPI:1992835896
Name:NEW BRUNSWICK COUNSELING CENTER
Entity Type:Organization
Organization Name:NEW BRUNSWICK COUNSELING CENTER
Other - Org Name:BURLINGTON COMPREHENSIVE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTOMSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:732-246-4025
Mailing Address - Street 1:320 SUYDAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2417
Mailing Address - Country:US
Mailing Address - Phone:732-246-4025
Mailing Address - Fax:732-246-3296
Practice Address - Street 1:605 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1022
Practice Address - Country:US
Practice Address - Phone:609-267-3610
Practice Address - Fax:609-267-9692
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW BRUNSWICK COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QR0405X
NJ40340261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0103306Medicaid
NJ7633009OtherWFNJ SAI