Provider Demographics
NPI:1053776450
Name:NORTH JERSEY COUNSELING ASSOCIATES LLC
Entity type:Organization
Organization Name:NORTH JERSEY COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOPKO-VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:845-544-6330
Mailing Address - Street 1:804 COUNTY RT 517
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07418-1804
Mailing Address - Country:US
Mailing Address - Phone:973-764-8845
Mailing Address - Fax:
Practice Address - Street 1:804 COUNTY RT 517
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07418-1804
Practice Address - Country:US
Practice Address - Phone:973-764-8845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00535800261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)