Provider Demographics
NPI:1174384218
Name:BEACON AT SEA COUNELING LLC
Entity type:Organization
Organization Name:BEACON AT SEA COUNELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:RAIZEL
Authorized Official - Last Name:GARFINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-692-8324
Mailing Address - Street 1:5 GREENTREE CTR
Mailing Address - Street 2:525 RT 73
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3422
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59 BOND ST APT 5
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4500
Practice Address - Country:US
Practice Address - Phone:973-692-8324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty