Provider Demographics
NPI:1295579811
Name:PLUM STREET COUNSELING LLC
Entity type:Organization
Organization Name:PLUM STREET COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEVERADA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:732-823-9770
Mailing Address - Street 1:415 LEMING RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-3151
Mailing Address - Country:US
Mailing Address - Phone:732-823-9770
Mailing Address - Fax:
Practice Address - Street 1:415 LEMING RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-3151
Practice Address - Country:US
Practice Address - Phone:732-823-9770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty