| Shirley Court Gonzalez, Lcsw Bcd Llc | |
|
470 Prospect Ave Ste 302 West Orange NJ 07052-4106 | |
| (877) 755-4401 | |
| (888) 511-7386 |
| Full Name | Shirley Court Gonzalez, Lcsw Bcd Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 470 Prospect Ave Ste 302, West Orange, New Jersey |
| Authorized Official Name and Position | Shirley Court (LCSW) |
| Authorized Official Contact | 8777554401 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shirley Court Gonzalez, Lcsw Bcd Llc 470 Prospect Ave Ste 302 West Orange NJ 07052-4106 Ph: (877) 755-4401 | Shirley Court Gonzalez, Lcsw Bcd Llc 470 Prospect Ave Ste 302 West Orange NJ 07052-4106 Ph: (877) 755-4401 |
| NPI Number | 1265105910 |
|---|---|
| Provider Enumeration Date | 07/28/2021 |
| Last Update Date | 07/28/2021 |
| Certification Date | 07/28/2021 |
| Medicare PECOS PAC ID | 5698171734 |
|---|---|
| Medicare Enrollment ID | O20210915000663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265105910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shirley Court |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316010796 PECOS PAC ID: 3375738495 Enrollment ID: I20210915001104 |
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