Provider Demographics
NPI:1356377113
Name:IRVINGTON COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:IRVINGTON COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, RN
Authorized Official - Phone:973-399-3132
Mailing Address - Street 1:21-29 WAGNER PLACE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111
Mailing Address - Country:US
Mailing Address - Phone:973-399-3132
Mailing Address - Fax:973-399-7552
Practice Address - Street 1:21-29 WAGNER PLACE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111
Practice Address - Country:US
Practice Address - Phone:973-399-3132
Practice Address - Fax:973-399-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YA0400X, 104100000X, 1041C0700X, 101Y00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0007803Medicaid
NJG1851949Medicare UPIN
NJ272316Medicare UPIN
NJ0006789000Medicare UPIN
NJ910002219-00Medicare UPIN
NJ0000333000Medicare UPIN
NJ05KCGMMedicare UPIN
NJ526310Medicare ID - Type Unspecified
NJ0005309483Medicare UPIN