| Beach Bungalo Limited Liability Company | |
|
892 Common Way Suite H Toms River NJ 08753 | |
| (732) 557-0354 | |
| (732) 286-4334 |
| Full Name | Beach Bungalo Limited Liability Company |
|---|---|
| Speciality | Social Worker |
| Location | 892 Common Way, Toms River, New Jersey |
| Authorized Official Name and Position | Sherry Lynn Goldman (PRESIDENT) |
| Authorized Official Contact | 7325570354 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beach Bungalo Limited Liability Company 712 E Long Branch Avenue Bayville NJ 08721 Ph: (732) 557-0354 | Beach Bungalo Limited Liability Company 892 Common Way Suite H Toms River NJ 08753 Ph: (732) 557-0354 |
| NPI Number | 1841326931 |
|---|---|
| Provider Enumeration Date | 02/26/2007 |
| Last Update Date | 11/15/2007 |
| Medicare PECOS PAC ID | 6901994748 |
|---|---|
| Medicare Enrollment ID | O20071113000295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841326931 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (New Jersey) | Secondary |
| 1041C0700X | Social Worker - Clinical | 44SC05201900 (New Jersey) | Primary |
| Provider Name | Sherry Lynn Goldman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760527964 PECOS PAC ID: 6103866454 Enrollment ID: I20050506000038 |
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