| Integrated Care Consulting Llc | |
|
615 Hope Road, Bldg 5b, 2nd Floor Eatontown NJ 07724-1277 | |
| (732) 389-0697 | |
| (732) 389-0611 |
| Full Name | Integrated Care Consulting Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 615 Hope Road, Bldg 5b, 2nd Floor, Eatontown, New Jersey |
| Authorized Official Name and Position | Elena Hammer (BILLING MANAGER) |
| Authorized Official Contact | 7323890697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrated Care Consulting Llc 134 Lighthouse Dr Waretown NJ 08758-2015 Ph: (732) 389-0697 | Integrated Care Consulting Llc 615 Hope Road, Bldg 5b, 2nd Floor Eatontown NJ 07724-1277 Ph: (732) 389-0697 |
| NPI Number | 1811416019 |
|---|---|
| Provider Enumeration Date | 09/19/2017 |
| Last Update Date | 03/15/2023 |
| Certification Date | 03/02/2023 |
| Medicare PECOS PAC ID | 3375917149 |
|---|---|
| Medicare Enrollment ID | O20230317000279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811416019 | NPI | - | NPPES |
| 1538285911 | Other | NJ | OWNER'S INDIVIDUAL NPI |
| 1760812051 | Other | NJ | PARTNER'S INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | John Larry Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538285911 PECOS PAC ID: 4284008053 Enrollment ID: I20230403001850 |
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