| Ccc Counseling Services | |
|
1401 New Rd Linwood NJ 08221-1121 | |
| (609) 225-9355 | |
| (609) 225-9355 |
| Full Name | Ccc Counseling Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1401 New Rd, Linwood, New Jersey |
| Authorized Official Name and Position | Jediedjah Rodrigues-pereira (PRESIDENT) |
| Authorized Official Contact | 6092259355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccc Counseling Services 1212 Todd Ct Lakewood NJ 08701-2256 Ph: (732) 814-4648 | Ccc Counseling Services 1401 New Rd Linwood NJ 08221-1121 Ph: (609) 225-9355 |
| NPI Number | 1225406762 |
|---|---|
| Provider Enumeration Date | 09/14/2015 |
| Last Update Date | 12/09/2018 |
| Medicare PECOS PAC ID | 1456611300 |
|---|---|
| Medicare Enrollment ID | O20180214001088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225406762 | NPI | - | NPPES |
| 1720329576 | Other | NJ | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 44SC05605500 (New Jersey) | Secondary |
| 251S00000X | Community/behavioral Health | 37LC0021100 (New Jersey) | Primary |
| Provider Name | Teresa M Dawe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982758652 PECOS PAC ID: 0648531145 Enrollment ID: I20180226000535 |
| Provider Name | Gabriella G Landman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750641643 PECOS PAC ID: 1153749098 Enrollment ID: I20200909003202 |
| Provider Name | Jamie L Basile |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043712573 PECOS PAC ID: 3678991544 Enrollment ID: I20200910000419 |
| Provider Name | Nicholas J Lacorte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134556582 PECOS PAC ID: 1759700883 Enrollment ID: I20200923001267 |
| Provider Name | Catherine Ottaviano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871129452 PECOS PAC ID: 8123447927 Enrollment ID: I20200929000178 |
| Provider Name | Beth D Wray |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619330644 PECOS PAC ID: 3274952080 Enrollment ID: I20200929000307 |
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