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19 Pine Valley Rd Jackson NJ 08527-4014 | |
| (732) 536-0076 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 19 Pine Valley Rd, Jackson, New Jersey |
| Authorized Official Name and Position | Beverly Baskin (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7325360076 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4400 Route 9 S Ste 1000 Freehold NJ 07728-1383 Ph: (732) 536-0076 | 19 Pine Valley Rd Jackson NJ 08527-4014 Ph: (732) 536-0076 |
| NPI Number | 1326101908 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 01/29/2025 |
| Certification Date | 01/29/2025 |
| Medicare PECOS PAC ID | 3577509173 |
|---|---|
| Medicare Enrollment ID | O20050711000141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326101908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 37PC00010500 (New Jersey) | Primary |
| Provider Name | Beverly Baskin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578626149 PECOS PAC ID: 1355377532 Enrollment ID: I20240606003712 |
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