Provider Demographics
NPI:1013149020
Name:JERSEY SHORE COUNSELING, LLC
Entity Type:Organization
Organization Name:JERSEY SHORE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:VACCARO
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCADC
Authorized Official - Phone:732-784-1810
Mailing Address - Street 1:780 COMMONS WAY
Mailing Address - Street 2:BUILDING J
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6431
Mailing Address - Country:US
Mailing Address - Phone:732-784-1810
Mailing Address - Fax:732-784-2850
Practice Address - Street 1:780 COMMONS WAY
Practice Address - Street 2:BUILDING J
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6431
Practice Address - Country:US
Practice Address - Phone:732-784-1810
Practice Address - Fax:732-784-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00059700101YA0400X
NJ37PC00234100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty