Provider Demographics
NPI:1174058994
Name:EMDR COUNSELING CENTER OF NJ
Entity type:Organization
Organization Name:EMDR COUNSELING CENTER OF NJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:201-429-5720
Mailing Address - Street 1:3600 ROUTE 66
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2605
Mailing Address - Country:US
Mailing Address - Phone:201-429-5720
Mailing Address - Fax:
Practice Address - Street 1:3600 ROUTE 66
Practice Address - Street 2:SUITE 150
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-2605
Practice Address - Country:US
Practice Address - Phone:201-429-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00544200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty