Provider Demographics
NPI:1184878449
Name:ADVANCED BEHAVIORAL COUNSELING OF NORTHERN NEW JERSEY LLC
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL COUNSELING OF NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DRUMM
Authorized Official - Suffix:
Authorized Official - Credentials:APN,BC
Authorized Official - Phone:973-579-9394
Mailing Address - Street 1:55 NEWTON SPARTA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2772
Mailing Address - Country:US
Mailing Address - Phone:973-579-9394
Mailing Address - Fax:973-579-9392
Practice Address - Street 1:55 NEWTON-SPARTA ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2056
Practice Address - Country:US
Practice Address - Phone:973-579-9394
Practice Address - Fax:973-579-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN0047373363LG0600X
NJ26NN004737300364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043879Medicare PIN
NJP19437Medicare UPIN