Provider Demographics
NPI:1205081569
Name:M & S PSYCHOTHERAPHY & COUNSELING INTEGRATED LLC
Entity type:Organization
Organization Name:M & S PSYCHOTHERAPHY & COUNSELING INTEGRATED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZILDE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-862-9877
Mailing Address - Street 1:568 PREAKNESS AVE
Mailing Address - Street 2:
Mailing Address - City:HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1048
Mailing Address - Country:US
Mailing Address - Phone:973-862-9877
Mailing Address - Fax:
Practice Address - Street 1:568 PREAKNESS AVE
Practice Address - Street 2:
Practice Address - City:HALEDON
Practice Address - State:NJ
Practice Address - Zip Code:07508-1048
Practice Address - Country:US
Practice Address - Phone:973-862-9877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00360100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0162426Medicaid