Provider Demographics
NPI:1427355973
Name:PACKANACK COUNSELING CENTER
Entity type:Organization
Organization Name:PACKANACK COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:TOONKEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:973-696-4016
Mailing Address - Street 1:134 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5602
Mailing Address - Country:US
Mailing Address - Phone:973-696-4016
Mailing Address - Fax:973-696-4016
Practice Address - Street 1:134 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5602
Practice Address - Country:US
Practice Address - Phone:973-696-4016
Practice Address - Fax:973-696-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004508001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty