Provider Demographics
NPI:1831946441
Name:MY QUIET PLACE, MENTAL HEALTH COUNSELING NJ LLC
Entity type:Organization
Organization Name:MY QUIET PLACE, MENTAL HEALTH COUNSELING NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUGOLETS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:201-247-2582
Mailing Address - Street 1:121 COLONY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4029
Mailing Address - Country:US
Mailing Address - Phone:718-813-9924
Mailing Address - Fax:646-846-4123
Practice Address - Street 1:420 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-7113
Practice Address - Country:US
Practice Address - Phone:718-813-9924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty