Provider Demographics
NPI:1962989442
Name:CROSSROADS COUNSELING & PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:CROSSROADS COUNSELING & PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:RIZZO
Authorized Official - Last Name:KOURGELIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:201-694-1648
Mailing Address - Street 1:36 RIVERVIEW TER
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-1607
Mailing Address - Country:US
Mailing Address - Phone:201-694-1648
Mailing Address - Fax:
Practice Address - Street 1:36 RIVERVIEW TER
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-1607
Practice Address - Country:US
Practice Address - Phone:201-694-1648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00165200101YA0400X
NJ44SC053004001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty