Provider Demographics
NPI:1265081921
Name:MONMOUTH INTEGRATIVE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MONMOUTH INTEGRATIVE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGNOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-895-9508
Mailing Address - Street 1:2517 HIGHWAY 35, BUILDING D
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-231-5170
Mailing Address - Fax:732-223-3098
Practice Address - Street 1:2517 HIGHWAY 35, BUILDING D
Practice Address - Street 2:SUITE 201
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736
Practice Address - Country:US
Practice Address - Phone:732-231-5170
Practice Address - Fax:732-223-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty